Clinical evaluation of patients with moderate to severe Alzheimer disease

Today, Alzheimer disease has become a serious risk to individual and public health, due to the significant incapacity it causes patients, its influence on family members and caregivers, along with the ensuing direct and indirect costs. OBJECTIVES: To build the profile of patients with moderate/severe AD, in the Geriatric Clinic Service of Cognitive Alterations of the Medical School at Universidade de São Paulo, by studying demential and comorbidity conditions and the degree of effectiveness of the therapies applied. METHODS: 30 patients with moderate or severe AD were selected, (77.8±7.29 years). Age, sex, schooling, prevalent comorbidities/treatments and respective clinical-laboratorial effectiveness were analyzed. Instruments were applied to evaluate the cognitive and behavioral condition and dementia control therapies. RESULTS: Most frequent comorbidities were arterial hypertension (80%) and diabetes (43.3%). A maximum dose of rivastigmine was observed in 43% of the patients, where 76% experienced adverse effects. Severe patients presented more cases of uncontrolled comorbidities, such as hypertension (P<0.001), as well as more behavioral alterations (P<0.001) and functional loss (P=0.004). Patients with greater behavioral alterations proved to be more functionally dependent (P=0.002), having less comorbidity control (P=0.004). CONCLUSIONS: In this population, a high incidence of comorbidities, frequent behavioral alterations and difficulties in therapy management were noted due to the severity of the dementia condition. New therapies for more adequate control of severe dementia should be studied.