Pharmaceutical agents used to slow the progression of AD include acetylcholinesterase inhibitors (tacrine, donepezil, rivastigmine, and galanta-mine). These agents block the breakdown of neurotransmitters in the brain and are used to lessen symptoms of mild to moderate AD. Their action extends cognitive function and improves behavioral symptoms for twelve months up to two years. Vitamin E or selegiline delays the progression of AD. Estrogen has been associated with a decreased risk of AD and enhanced cognitive functioning. Its antioxidant and anti-inflammatory effects enhance the growth of neuron processes for memory function. Ginkgo biloba has provided moderate cognitive improvement with few ill effects. Delusions and hallucinations often develop in moderately impaired patients. In the absence of agitation or combativeness, the best treatment is reassurance and distraction. Delusions and hallucinations accompanied by agitation and combativeness can be treated with low doses of antipsychotic or antidepressant medications. Medications may also be used to control wandering, anxiety, insomnia, and depression.
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