Pharmacotherapy and Patient Adherence in Alzheimer's Disease

Pharmacotherapy for Alzheimer’s disease centres on symptomatic relief through acetylcholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine. These agents modestly improve cognition and function but do not alter underlying neurodegeneration. Optimal outcomes depend critically on patient adherence and persistence with prescribed regimens. Suboptimal adherence undermines cognitive benefits, increases healthcare utilisation and exacerbates caregiver burden. Factors influencing adherence range from drug-related variables—such as dosage frequency, side-effect profiles and routes of administration—to patient-centred determinants including cognition, comorbidities and social support. Caregiver engagement, healthcare policy and institutional frameworks also shape persistence and discontinuation rates. Emerging real-world evidence underscores the need for integrated strategies that combine pharmacological planning, electronic monitoring and caregiver education. Globally, improving adherence offers the potential to prolong functional independence, reduce hospital admissions and optimise resource allocation in aging societies.

Research from Nature Portfolio

A multi-centrepredictive study applied a harmonised electronic health record model to assess anti-dementia drug use among over 8 000 newly diagnosed patients across five hospitals. Donepezil emerged as the most frequently prescribed agent, with memantine, rivastigmine and galantamine following. Prescription trends over an 11-year span showed a steady increase in donepezil initiation, while combination pathways varied according to the cholinesterase inhibitor chosen. Persistence at 12 months hovered around 50 percent for donepezil and memantine, and approximately 40 percent for other agents. The analysis revealed heterogeneity in treatment pathways and highlighted drug-specific patterns of switching and discontinuation, emphasising the need for tailored adherence interventions.

Pharmacotherapy and Patient Adherence in Alzheimer's Disease publication trend

The graph below shows the total number of articles in pharmacotherapy and patient adherence in alzheimer's disease across all publications each year (not limited to Nature Index journals).

Technical terms

Pharmacotherapy: Treatment of disease using pharmaceutical agents.

Patient adherence: Degree to which a patient’s medication-taking behaviour corresponds with prescribed regimens.

Medication persistence: Length of time from initiation to discontinuation of a prescribed therapy.

Acetylcholinesterase inhibitors: Drugs that block the enzyme acetylcholinesterase, increasing synaptic acetylcholine.

N-methyl-D-aspartate (NMDA) receptor antagonist: Agent that inhibits NMDA receptor activity, exemplified by memantine.

Medication possession ratio (MPR): Metric of adherence calculated as the proportion of days covered by dispensed medication.

References

1. Non-adherence to antidementia medications and associated factors: a study of Spanish population-based registry data. Frontiers in Pharmacology (2024).
2. Changes in dementia treatment patterns associated with changes in the National Policy in South Korea among patients with newly diagnosed Alzheimer’s disease between 2011 and 2017: results from the multicenter, retrospective CAPTAIN study. BMC Public Health (2024).
3. Analysis of treatment pattern of anti-dementia medications in newly diagnosed Alzheimer’s dementia using OMOP CDM. Scientific Reports (2022).
4. Role of caregivers on medication adherence management in polymedicated patients with Alzheimer's disease or other types of dementia. Frontiers in Public Health (2022).