What is the recommended treatment for dementia?

From the Guidelines

The most effective treatment for dementia involves a comprehensive approach combining medications and non-pharmacological interventions, with cholinesterase inhibitors like donepezil, rivastigmine, and galantamine prescribed for mild to moderate Alzheimer's disease, and memantine used for moderate to severe cases, as recommended by the most recent study 1. The goal of treatment is to delay clinical decline, benefit cognitive function, and help reduce symptoms such as memory loss and confusion.

• Medications:
  • Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild to moderate Alzheimer's disease
  • Memantine for moderate to severe Alzheimer's disease
• Non-pharmacological interventions:
  • Cognitive stimulation therapy
  • Reality orientation
  • Physical exercise
  • Creating structured routines
  • Managing behavioral symptoms with antipsychotics like risperidone or quetiapine at low doses, only when non-drug approaches fail
  • Addressing underlying conditions like depression, pain, or infections that can worsen dementia symptoms
  • Caregiver education and support
  • Creating a safe, familiar environment for the patient According to the most recent study 1, dementia affects people differently, and various types of dementia have somewhat different symptomatology, but common symptoms include problems with reasoning, communication, decision making, personality changes, and effects on short‐term and long‐term memory.
• The study also highlights the importance of person‐centered care, including psychosocial interventions, as the first line of prevention and treatment for behavioral and psychological symptoms of dementia (BPSD) and for supporting quality of life generally in people with dementia.
• Medication should be used as a carefully monitored, short‐term, last resort in specific cases, due to the attendant increased risk of adverse effects, including falls, stroke, and death, as noted in the study 1. The treatment plan should be regularly monitored and adjusted as the disease progresses, taking into account the severity of symptoms and the individual's needs, as recommended by the study 1.
• The study 1 also notes that the combination of memantine and donepezil is recommended for severe Alzheimer's disease in some countries.
• However, the most recent study 1 highlights the importance of considering the individual's needs and the severity of symptoms when making treatment decisions.

From the FDA Drug Label

Memantine hydrochloride is indicated for the treatment of moderate to severe dementia of the Alzheimer’s type. The recommended treatment for dementia is memantine for moderate to severe dementia of the Alzheimer’s type 2.

• Rivastigmine may also be considered for mild-to-moderate Alzheimer's disease and dementia associated with Parkinson's disease 3.

From the Research

Treatment for Dementia

• The current recommended standard of care for the symptomatic treatment of mild to moderate Alzheimer's disease is cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine 4.
• These medications have demonstrated efficacy in improving cognition, function, and behavior in patients with mild to severe Alzheimer's disease and other forms of dementia 5, 4.
• Cholinesterase inhibitors, such as donepezil, may be used to treat mild to severe dementia, while memantine may be used for moderate to severe dementia 6.
• Rivastigmine can be used to treat symptomatic Parkinson disease dementia 6.

Non-Pharmacological Interventions

• Non-pharmacological approaches, including cognitively engaging activities, physical exercise, and socialization, may also be beneficial for patients with dementia 6, 7.
• Non-pharmacological interventions, such as multi-sensory stimulation and activities-based interventions, may reduce neuropsychiatric symptoms of dementia 8.

Effectiveness of Treatments

• Pharmacological treatments, such as donepezil and galantamine, have been shown to be associated with better outcomes compared to placebo for severity of symptoms, activities of daily living, and clinical impression of change 8.
• Non-pharmacological treatments may be effective in reducing neuropsychiatric symptoms, but the quality of evidence remains low 8.

Limitations of Current Treatments

• The benefits of cholinesterase inhibitors are not sustained indefinitely, and the illness continues to progress even while patients are receiving treatment 4.
• Current prevention and treatment approaches to dementia have been less than optimally successful, and substantial investments in dementia research are needed to provide new answers to reducing the burden of dementia worldwide 7.