Patient handout

Alzheimer Disease (outpatient + biomarker era)

PRODUCTION

1. Your condition

This handout is for alzheimer disease (outpatient + biomarker era). Your care team identified this based on: insidious episodic memory decline + word-finding + iadl impact (nia-aa 2011 mckhann pmid 21514250).

Other reasons your team may use this plan: amnestic mci — preserved iadl but objective episodic memory deficit (albert aan mci pmid 21514249); csf aβ42/40 low or amyloid-pet positive or blood p-tau217 elevated (nia-aa 2018 pmid 29653606); caregiver-corroborated cognitive decline ≥6 mo (nia-aa 2011).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
donepezil	5 mg PO QHS	PO	daily; titrate to 10 mg after 4-6 wk	AAN 2018 PMID 29282327 modest symptomatic benefit; GI + bradycardia + sleep ADRs
rivastigmine	4.6 mg/24h patch	transdermal	daily; titrate to 9.5 then 13.3 mg/24h q4 wk	Patch reduces GI ADRs; FDA-approved for PDD/DLB overlap (McKeith 2017)
galantamine	8 mg ER PO daily	PO	daily; titrate to 16 then 24 mg q4 wk	Weak nicotinic modulation (AAN 2018)

Plan: Cholinesterase inhibitor + memantine ladder (AAN 2018; NICE 2024 dementia)

3. When to call your provider

Contact your care team if any of the following happen:

Acute delirium superimposed → ED + workup
ARIA-E with neuro deficit on mAb → pause + urgent MRI + neurology
Severe BPSD refractory to non-pharm + SSRI → consider time-limited antipsychotic with documented goal
Behavioural crisis with safety risk → ED + geriatric psychiatry
Caregiver burnout → respite + APS / home health intensification

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Severe AD — MMSE <10, CDR 3, total dependence, mutism / immobility late, FAST 6-7 (NIA-AA 2011)
ARIA-E — vasogenic edema on FLAIR/T2 in mAb recipient; symptomatic (headache, visual change, confusion, seizure) OR asymptomatic surveillance finding (CLARITY-AD PMID 36449413)
ARIA-H — new microhemorrhage (≤10 mm hypointensity on GRE/SWI) or superficial siderosis in mAb recipient (CLARITY-AD PMID 36449413)
Wandering — elopement risk; MedicAlert / GPS device / secured exits required

5. Follow-up

Caregiver education + dementia care navigator; driving cessation per MoCA / FAST trajectory; capacity assessment + advance directives / POLST; palliative referral at FAST 7 (NICE 2024 dementia; APA 2024)

6. Sources

Guideline: NIA-AA 2018 research framework (Jack PMID 29653606) + NIA-AA 2011 clinical criteria (McKhann PMID 21514250) + AAN 2024 anti-amyloid mAb appropriate-use + APA 2024 BPSD + AGS Beers 2023