New Medicines for Dementia
The evidence provided does not support any truly "new" medicines for dementia beyond the established FDA-approved medications: cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine, which remain the standard pharmacological options. 1, 2
Current FDA-Approved Medications
The only medications approved for dementia treatment are:
- Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) for mild to moderate Alzheimer's disease 1, 2, 3
- Memantine for moderate to severe dementia 1, 2, 3
These medications do not cure dementia or halt disease progression—they only provide modest symptomatic benefit and may slow progression temporarily. 1, 4
Clinical Reality of "Approved" Treatments
Modest Benefits at Best
- The clinical improvements from these medications are often marginal despite achieving statistical significance in trials 2
- Most supporting studies are short-duration (6 months), limiting understanding of long-term benefits 2
- Effects on cognition and global function are more consistently demonstrated than effects on behavior and quality of life 2
Treatment Selection Algorithm
Base your decision to initiate therapy on individualized assessment of the patient, considering: 1
- Tolerability profile of the specific agent
- Adverse effect profile (cholinesterase inhibitors cause GI side effects; memantine has fewer side effects)
- Ease of use (dosing frequency, patch vs. oral formulations)
- Cost of medication
The evidence is insufficient to demonstrate superiority of one agent over another, so practical factors should guide selection. 1
Non-Pharmacological Approaches Should Be Primary
Non-pharmacological interventions should take precedence over medications, particularly for behavioral and psychological symptoms of dementia. 2
Effective non-pharmacological interventions include:
These approaches have demonstrated improvements in depression scores, sleep disturbances, daily functioning (ADL/IADL), and quality of life without the side effects of medications. 5
Important Caveats
No Disease-Modifying Therapies Available
- Current approved medications are purely symptomatic and do not modify disease course 1, 4
- Research is ongoing for disease-modifying therapeutics targeting amyloid, tau protein, and inflammatory pathways, but none are yet approved 4, 6
Avoid Unproven Treatments
- Lithium is NOT recommended for dementia treatment and does not appear in dementia treatment guidelines 7
- Lithium carries significant toxicity risks requiring monitoring and has no established efficacy in dementia 7
- Other compounds being studied for repurposing (piracetam, Ginkgo biloba) lack robust evidence and long-term safety data 3, 8
The Evidence Gap
There is an urgent need for further research on the clinical effectiveness of pharmacologic management of dementia, as current evidence remains limited. 1