From the Guidelines
Dementia management should prioritize high-quality, person-centered care, including psychosocial interventions, as the first line of prevention and treatment for behavioral and psychological symptoms of dementia (BPSD), with medication used as a carefully monitored, short-term, last resort in specific cases. The pathophysiology of dementia involves progressive cognitive and physical impairment, with various types of dementia having somewhat different symptomatology, including problems with reasoning, communication, decision making, personality changes, and effects on short-term and long-term memory 1.
Key Aspects of Dementia Management
- Focus on person-centered care: This approach emphasizes the individual's needs, preferences, and values, and is recognized as the most effective way to support quality of life in people with dementia (PLWD) 1.
- Psychosocial interventions: These interventions, such as cognitive stimulation therapy, reality orientation, and environmental modifications, are essential components of comprehensive dementia care and can help reduce BPSD 1.
- Medication use: Medications like donepezil, rivastigmine, galantamine, and memantine can temporarily reduce or slow down the progression of some cognitive symptoms, but should be used judiciously and with careful monitoring due to potential adverse effects 1.
- Caregiver education and support: Educating and supporting caregivers is crucial in providing comprehensive dementia care, as they play a vital role in managing BPSD and supporting the daily needs of PLWD 1.
Understanding Dementia Progression
- Early-stage/mild dementia: Characterized by milder symptoms, such as difficulty thinking of the right word or name, with minimal functional impact 1.
- Moderate dementia: Marked by more pronounced symptoms, such as confusion about where they are or what day it is, requiring some assistance with daily activities 1.
- Late-stage/advanced dementia: Characterized by severe symptoms, such as loss of awareness of their surroundings, with many individuals requiring full-time care 1.
By prioritizing person-centered care, psychosocial interventions, and careful medication use, healthcare providers can improve the quality of life for PLWD and their caregivers, while also reducing the risk of adverse effects associated with medication use 1.
From the FDA Drug Label
Current theories on the pathogenesis of the cognitive signs and symptoms of Alzheimer’s disease attribute some of them to a deficiency of cholinergic neurotransmission. Donepezil hydrochloride is postulated to exert its therapeutic effect by enhancing cholinergic function This is accomplished by increasing the concentration of acetylcholine through reversible inhibition of its hydrolysis by acetylcholinesterase. There is no evidence that donepezil alters the course of the underlying dementing process.
The pathophysiology of dementia, specifically Alzheimer's disease, is attributed to a deficiency of cholinergic neurotransmission. The management of dementia involves enhancing cholinergic function through reversible inhibition of acetylcholinesterase, which increases the concentration of acetylcholine. Donepezil hydrochloride is used to exert this therapeutic effect, but it does not alter the course of the underlying dementing process 2.
- Key points:
- Deficiency of cholinergic neurotransmission contributes to dementia
- Enhancing cholinergic function helps manage dementia
- Donepezil hydrochloride is used to enhance cholinergic function
- Donepezil does not alter the course of the underlying dementing process
From the Research
Pathophysiology of Dementia
- Dementia is a debilitating neurological condition characterized by the aggregation of misfolded proteins and cerebrovascular disease 3
- The most common forms of late-onset dementia are Alzheimer's disease, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia 3
- Mixed neuropathologies are frequently detected in the brains of older people with dementia and have important clinical implications 3
- Alzheimer's disease is characterized by two hallmark pathologies: β-amyloid plaque deposition and neurofibrillary tangles of hyperphosphorylated tau 4
Management of Dementia
- Donepezil, a cholinesterase inhibitor, is approved for use across the full spectrum of mild, moderate, and severe Alzheimer's disease 5, 6, 7
- Donepezil has been shown to improve cognitive function, activities of daily living, and global clinical state in people with mild, moderate, or severe dementia due to Alzheimer's disease 5, 6, 7
- The optimal dose of donepezil is 10 mg/day, with higher doses (23 mg/day) showing no greater benefits but increased adverse events 5, 6
- Treatment with donepezil is associated with a higher risk of adverse events, such as nausea, vomiting, diarrhea, and anorexia, but these are generally mild and temporary 5, 7
- There is moderate-quality evidence that donepezil is effective in improving cognitive function, activities of daily living, and clinician-rated global clinical state in people with dementia due to Alzheimer's disease 5