Results: We identified 940 articles, of which 838 were selected
for further study. Thirty-four articles were judged to
be of at least good or fair quality and were used to generate
17 recommendations. Assessment of severe Alzheimer
disease should include the measurement of cognitive function
and the assessment of behaviour, function, medical
status, nutrition, safety and caregiver status. Management
could include treatment with a cholinesterase inhibitor or
memantine, or both. Treatment of neuropsychiatric symptoms
begins with nonpharmacologic approaches to addressing
behavioural problems. Severe agitation, aggression
and psychosis, which are potentially dangerous to the
patient, the caregiver and others in the environment, can
be treated with atypical antipsychotics, with consideration
of their increased risk of cerebrovascular events and death.
All pharmacologic approaches require careful monitoring
and periodic reassessment to determine whether continued
treatment is necessary. Caregiver support and use of
community resources are essential.