Medications used in dementia: a review of evidence

Abstract

Background Dementia is an acquired global impairment of intellect, memory and personality, without impairment of consciousness. It is usually progressive in nature. The management of dementia is mainly two faceted; pharmacological and non-pharmacological.Aims To review the evidence regarding the efficacy of cholinesterase inhibitors, memantine and antipsychotics, in the treatment of dementia.Methods We searched ALOIS, Cochrane database, PubMed, Scopus and Google scholar using key words; dementia, cognitive enhancers, cholinesterase inhibitors and memantine as individual words for relevant review articles.Results There is evidence of efficacy of donepezil, rivastigmine and galantamine in mild to moderate Alzheimer’s dementia (AD). Evidence also suggests that memantine has efficacy in moderate to severe AD. Further, memantine may benefit behavioural and psychological symptoms of dementia (BPSD), and has also being considered for the treatment of dementias of lesser severity. Evidence also supports the use of AChE inhibitors in vascular dementia and dementia due to Parkinson’s disease (PDD). But evidence regarding efficacy in dementia of Lewy Body (DLB) is not very strong. Antipsychotics can be used for the management of BPSD if other measures fail, keeping in mind the black box warning for the risk of stroke. The use of antidepressants and mood stabilisers are limited by the lack of strong evidence.Conclusion The current evidence supports the use of cholinesterase inhibitors and memantine in patients with Alzheimer’s dementia, vascular dementia and PDD, with a positive impact on global assessment, cognitive function, behavioural disturbance and activities of daily living rating scales. The effect in DLB remains unclear.SL J Psychiatry 2015; 6(2): 3-8