ABSTRACT
The repertoire of behavioral symptoms depends on the degree of severity of Alzheimer’s disease (AD). In addition to cognitive symptoms such as memory loss and language impairment, patients with AD often develop behavioral symptoms. While cognitive symptoms are required for the diagnosis of AD and are relentlessly progressive, behavioral symptoms are not inevitable, usually fluctuate in severity, and may be intermittent or transient. Before initiating treatment, the physician must determine whether physical illness, medications, or environmental or interpersonal factors are contributing to the behavioral symptoms. Elderly patients are more sensitive than younger adults to medication effects and side effects. The combination of aging and AD produces marked deficits of brain neurotransmitter systems, particularly acetylcholine, dopamine, norepinephrine, and serotonin. Delusions and hallucinations occur most often in patients with AD who have mild to moderately severe dementia. Anxiety is relatively uncommon in patients with AD. Several classes of medications may be used, most of which can produce tolerance with long-term use.
