From the Guidelines
Medications for senile dementia, including cholinesterase inhibitors and NMDA receptor antagonists, should be used to manage symptoms and potentially slow disease progression, with treatment plans individualized based on the specific type of dementia, disease stage, patient tolerance, and comorbidities, as supported by studies such as 1 and 1.
Overview of Pharmacological Treatments
The main drug classes for treating dementia include:
- Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) which increase acetylcholine levels in the brain to improve cognitive function
- NMDA receptor antagonists (memantine) which regulate glutamate activity to protect brain cells These medications are typically started at low doses and gradually increased to minimize side effects like nausea, vomiting, and diarrhea.
Treatment Approach
Treatment should begin early after diagnosis and continue long-term, with regular monitoring for effectiveness and side effects.
- Cholinesterase inhibitors are generally first-line for mild to moderate dementia
- Memantine may be added for moderate to severe cases Some patients benefit from combination therapy. Beyond medications, comprehensive dementia care should include non-pharmacological approaches such as cognitive stimulation, physical activity, and caregiver support, as noted in 1.
Considerations for Treatment
The choice of medication depends on the specific type of dementia, disease stage, patient tolerance, and comorbidities, requiring individualized treatment plans developed with healthcare providers, as recommended in 1. Limitations of available studies, including short duration and limited evaluation of behavior and quality-of-life outcomes, should be considered when making treatment decisions, as discussed in 1 and 1.
From the FDA Drug Label
1.1 Alzheimer's Disease Rivastigmine tartrate capsules, USP are indicated for the treatment of mild-to-moderate dementia of the Alzheimer's type (AD). 1.2 Parkinson's Disease Dementia Rivastigmine tartrate capsules, USP are indicated for the treatment of mild-to-moderate dementia associated with Parkinson's disease (PD).
- INDICATIONS AND USAGE Memantine hydrochloride is indicated for the treatment of moderate to severe dementia of the Alzheimer’s type.
The pharmacological treatments for Alzheimer's disease (AD) and other forms of dementia are:
- Rivastigmine: indicated for the treatment of mild-to-moderate dementia of the Alzheimer's type (AD) and mild-to-moderate dementia associated with Parkinson's disease (PD) 2 2.
- Memantine: indicated for the treatment of moderate to severe dementia of the Alzheimer’s type 3. Their roles are to treat the symptoms of AD and other forms of dementia. The recommended dosage of rivastigmine is 6 mg to 12 mg per day, administered twice a day, while the dosage of memantine is not specified in the provided text.
From the Research
Pharmacological Treatments for Alzheimer's Disease (AD) and Other Forms of Dementia
The current pharmacological treatments for AD and other forms of dementia include:
- Cholinesterase inhibitors (ChEIs) such as donepezil, rivastigmine, and galantamine, which are recommended for mild to moderate AD 4, 5, 6
- N-methyl-D-aspartate (NMDA) receptor antagonists such as memantine, which is authorized for moderate to severe dementia 5, 7
- Amyloid-beta (Aβ) monoclonal antibodies such as aducanumab, which is approved for mild AD 5
Roles of Pharmacological Treatments
The roles of these treatments include:
- Enhancing cholinergic neurotransmission in the brain to improve cognitive function, activities of daily living, and behavioral symptoms 4, 6
- Modifying the manifestations of AD, although they do not reverse the disease or stop its progression 4, 6
- Providing symptomatic relief and slowing down the progression of the disease 5, 7
- Offering additive benefits when used in combination, such as combination therapy with memantine and ChEIs 7
Efficacy and Safety of Pharmacological Treatments
The efficacy and safety of these treatments have been demonstrated in various studies, including:
- Donepezil, which has been shown to improve cognitive function, activities of daily living, and clinician-rated global clinical state in patients with mild, moderate, or severe AD 8
- ChEIs, which have been found to produce improvements in cognitive function, global clinical state, activities of daily living, and behavior in patients with mild, moderate, or severe dementia due to AD 6
- Memantine, which has been shown to provide benefits on measures of cognition, functioning, behavior, and global status in patients with severe AD 7
Adverse Effects and Tolerability
The adverse effects and tolerability of these treatments have also been studied, including: