Treatment of Alzheimer's Disease with Mild to Moderate Cognitive Impairment

This protocol covers the management of clinically confirmed Alzheimer's disease in patients presenting with mild to moderate cognitive impairment — a stage at which structured pharmacological and non-pharmacological intervention can yield meaningful functional benefit.

Clinical Scenario

The patient has a clinical diagnosis of Alzheimer's disease accompanied by mild to moderate cognitive impairment. Evidence from meta-analyses supports the benefit of targeted pharmacotherapy in this population, with measurable effect sizes demonstrated for specific agents.

Treatment Approach

The protocol centres on a cholinesterase inhibitor, titrated gradually, with cognitive stimulation considered as a complementary strategy in eligible cases. The complete regimen — including specific agent selection, titration schedule, and combination guidance — is available in the full protocol.

Clinical Goal

Improved cognitive function, expected to be appreciable within 12 weeks from the start of treatment.

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References

DOI: 10.1016/S0140-6736(25)01329-7

Meta-analyses indicate that galantamine (≥24 mg) and donepezil (10 mg) are most effective for mild to moderate Alzheimer's disease, with moderate effect sizes (galantamine 0·5 and donepezil 0·4).
Adding cognitive stimulation to cholinesterase inhibitors might improve outcomes in mild Alzheimer's disease.
Improved cognitive function can be appreciated within 12 weeks from treatment inception.

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