Pharmacological treatment of dementia

This chapter summarizes the available clinical evidence for pharmacological treatments for dementia with an emphasis on practical considerations and realistic expectations of currently available antidementia drugs. It covers the treatment of both cognitive and non-cognitive symptoms. The search for specific treatments for dementia has inevitably concentrated on Alzheimer’s disease (AD), partly because it is the commonest cause of dementia and partly because scientific progress has provided more potential therapeutic targets for AD than other dementias. AD is treated with AChEIs (donepezil, galantamine, or rivastigmine) and the goals of treatment should be explained at the commencement of treatment. For dementia with Lewy bodies (DLB) use AChEI, especially for hallucinations and other behavioural disturbance and consider memantine or increasing dose if BPSD symptoms persist. For vascular dementia (VaD) look for sources of emboli (e.g. carotid disease) and consider anticoagulation for atrial fibrillation, and low-dose aspirin. Ensure other relevant conditions (e.g. hypertension and diabetes) are being managed appropriately.