What are the treatments for dementia?

From the Guidelines

Dementia treatments should prioritize a combination of medication and non-medication approaches, with a focus on individualized assessment and management of symptoms, as well as lifestyle modifications to slow disease progression, as recommended by the most recent and highest quality study 1.

Medication Approaches

• Cholinesterase inhibitors, such as donepezil (Aricept, 5-10mg daily), rivastigmine (Exelon, 1.5-6mg twice daily), and galantamine (Razadyne, 4-12mg twice daily), are first-line medications for mild to moderate Alzheimer's disease, increasing acetylcholine levels in the brain 1.
• Memantine (Namenda, 10mg twice daily) may be added for moderate to severe cases, regulating glutamate activity 1.

Non-Medication Approaches

• Cognitive stimulation therapy, regular physical exercise (30 minutes daily), maintaining social connections, establishing routines, and creating a safe environment are equally important non-medication approaches 1.
• Treating underlying conditions like depression, managing cardiovascular risk factors, and ensuring proper nutrition can slow progression 1.
• Caregivers should establish clear communication strategies, use memory aids, and seek support groups 1.

Key Considerations

• Treatment effectiveness varies by individual, and medications typically manage symptoms rather than cure the disease, with benefits potentially diminishing as the condition progresses 1.
• The choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as the evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia 1.

From the FDA Drug Label

Memantine hydrochloride is indicated for the treatment of moderate to severe dementia of the Alzheimer’s type. The effectiveness of rivastigmine tartrate as a treatment for dementia associated with Parkinson's disease is demonstrated by the results of 1 randomized, double-blind, placebo-controlled clinical investigation in patients with mild-to-moderate dementia, with onset at least 2 years after the initial diagnosis of idiopathic Parkinson's disease.

Dementia Treatments:

• Memantine is used to treat moderate to severe dementia of the Alzheimer’s type 2.
• Rivastigmine is used to treat mild-to-moderate dementia associated with Parkinson's disease 3.

From the Research

Dementia Treatments

• The current recommended standard of care for the symptomatic treatment of mild to moderate Alzheimer's disease is cholinesterase inhibitors, including donepezil, rivastigmine, and galantamine 4.
• These medications have demonstrated efficacy in improving cognition, function, and behavior in patients with Alzheimer's disease and other forms of dementia 4, 5.
• However, the benefits of cholinesterase inhibitors are not sustained indefinitely, and the illness continues to progress even while patients are receiving treatment 4.
• Cholinesterase inhibitors have also been studied for the treatment of vascular dementia and other vascular cognitive impairments, with donepezil, galantamine, and rivastigmine showing a slight beneficial effect on cognition, although the size of the change is unlikely to be clinically important 6.
• Memantine is another pharmacotherapeutic option for the treatment of Alzheimer's disease, which improves cognitive functions and behavioral disturbances more efficiently than the placebo, both as monotherapy and in combination with donepezil 7.
• The benefits and risks associated with cholinesterase inhibitor therapy in Alzheimer's disease have been evaluated, with modest but significant therapeutic benefits, despite higher rates of treatment discontinuation and side effects than placebo 8.

Cholinesterase Inhibitors

• Donepezil, galantamine, and rivastigmine are the most commonly used cholinesterase inhibitors for the treatment of Alzheimer's disease 4, 5.
• These medications work by compensating for reduced cholinergic neurotransmission, which is a feature of Alzheimer's disease and other forms of dementia 6, 5.
• The efficacy and safety of cholinesterase inhibitors have been evaluated in several studies, with donepezil, galantamine, and rivastigmine showing a slight beneficial effect on cognition, although the size of the change is unlikely to be clinically important 6.
• Cholinesterase inhibitors are generally well-tolerated, with side effects that tend to be dose-related and are most problematic during dose titration 5, 8.

Other Treatments

• Memantine is a pharmacotherapeutic option for the treatment of Alzheimer's disease, which improves cognitive functions and behavioral disturbances more efficiently than the placebo, both as monotherapy and in combination with donepezil 7.
• Combination treatments with memantine and one cholinesterase inhibitor have been evaluated, with donepezil and memantine showing the most useful treatment for Alzheimer's disease 7.