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Family Medicine

Answer 5
  1. Start sertraline only. Cognitively-impaired patients have frequent concurrent depression, and the use of antidepressants (sertraline and others) is recommended only for those who are identified as meeting the criteria for adjustment disorder with depressed mood or major depression. Current clinical guidelines include several pharmacologic recommendations.2 Cholinesterase inhibitors have been shown to slow (but not reverse) cognitive decline, while offering improvement in cognition, mood, and activities of daily living enhancement. These improvements are often modest but have been shown to delay nursing home placement by up to 2 years. Likewise, vitamin E has been shown to decrease functional decline compared with placebo. Obtaining the support of professionals with experience and expertise in the support of dementia families and clarifying advanced directives are also important.

    2. Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association of Geriatric Psychiatry, and Alzheimer╣s Association, and the American Geriatrics Society. JAMA 1997;278:1363-71.

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