From the Guidelines
Steroid use in patients with dementia or at risk of cognitive decline should generally be avoided or used with extreme caution due to their potential to worsen cognitive function. When steroids are medically necessary, physicians should use the lowest effective dose for the shortest possible duration, as recommended by recent guidelines 1. For example, if prednisone is required, starting at 5-10mg daily rather than higher doses may reduce cognitive side effects. Short-acting steroids like hydrocortisone may be preferable to longer-acting ones like dexamethasone when appropriate for the condition being treated.
The potential harms of steroid use in this population are significant, and the benefits of alternative treatments should be carefully considered. According to a review of 26 studies, there is no evidence that medications or supplements, including low-dose aspirin, statins, nonsteroidal anti-inflammatory drugs, gonadal steroids, and dietary supplements, provide a benefit in global cognitive or physical function in persons with mild to moderate dementia or mild cognitive impairment (MCI) 1.
If steroids must be used, close monitoring of cognitive function is essential, with regular assessments using tools like the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA). Steroids can cause or exacerbate cognitive impairment through multiple mechanisms, including effects on hippocampal function, neurotransmitter systems, and vascular health. Patients and caregivers should be educated about potential cognitive side effects and instructed to report any changes in memory, thinking, or behavior.
Some key points to consider when using steroids in patients with dementia or at risk of cognitive decline include:
- Using the lowest effective dose for the shortest possible duration
- Preferably using short-acting steroids like hydrocortisone
- Close monitoring of cognitive function
- Educating patients and caregivers about potential cognitive side effects
- Considering alternative non-steroidal treatments when possible.
From the Research
Steroid Use in Patients with Dementia or at Risk of Cognitive Decline
There is no direct evidence in the provided studies regarding the use of steroids in patients with dementia or at risk of cognitive decline.
Alternative Treatments for Dementia
- Cholinesterase inhibitors such as donepezil, galantamine, and rivastigmine are used to treat dementia due to Alzheimer's disease 2, 3, 4.
- Donepezil has been shown to improve cognitive function, clinical global impression, and activities of daily living in patients with mild to moderate vascular cognitive impairment 3.
- Cognitive training and cholinergic drugs such as donepezil may be effective in improving cognitive processes and affective states in patients with Alzheimer's disease 5.
- Donepezil and cognitive remediation therapy may be beneficial in treating alcohol use disorder-related mild cognitive impairment (AUD-MCI) 6.
Adverse Events and Safety
- Donepezil has been associated with adverse events such as nausea, diarrhea, dizziness, and headache 2, 3, 4.
- The risk of adverse events may be higher with higher doses of donepezil 4.
- Galantamine may also be associated with adverse events such as nausea, diarrhea, and dizziness 2.
Recommendations
There are no specific recommendations for steroid use in patients with dementia or at risk of cognitive decline based on the provided studies. However, cholinesterase inhibitors such as donepezil may be considered as a treatment option for dementia due to Alzheimer's disease or vascular cognitive impairment, under the guidance of a healthcare professional 2, 3, 4.