J Korean Geriatr Psychiatry.  2008 Jun;12(1):17-27.

Update Treatment of Dementia: Focus on Pharmacologic Treatment

• Lee KJ

Abstract

Dementia is an increasingly common diagnosis in our population, and the numbers are expected to rise exponentially in coming years. Within the past decades research has progressed rapidly on multiple fronts, including epidemiology, etiology, pathology, diagnosis, and treatment. This article reviews the evidence for the effecacy of various pharmacologic treatments on dementia. Acetylcholinesterase inhibitors and NMDA antagonist are effective in patients with Alzheimer's disease. Benefit for vitamine E, anti-inflammatory drugs and ginko biloba have been suggested, but supporting evidence is not strong. And although antipsychotics have efficacy and safety in the treatment of aggression, agitation, and psychosis in patients with Alzheimer's disease, adverse effects limit their overall effectiveness. SSRI and atypical antipsychotic agents are frequently used to manage behavioral abnormalities associated with frontotemporal dementia. Cholinesterase inhibitors and levodopa have been reported to improve hallucination, cognition, apathy in dementia with Lewy bodies. And pharmacological intervention was largely ineffective in the management of corticobasal degeneration. Phenothiazine, quinacrine are being evaluated as treatment for CJD patients in trials. Cholinergic deficits in vascular dementia are due to ischemia of basal forebrain nuclei and of cholinergic pathways and can be treated with the use of the cholinesterase inhibitors. Future studies, directed to distinct causal and pathological factors, will be needed to enable therapeutic advances in dementia. Larger, well-controlled treatment studies are required to reach more definitive conclusions about treatment efficacy.

Keyword

Dementia; Pharmacologic treatment; Alzheimer's disease

MeSH Terms

Aggression
Alzheimer Disease
Antipsychotic Agents
Apathy
Cholinesterase Inhibitors
Cholinesterases
Cognition
Dementia
Dementia, Vascular
Dihydroergotamine
Frontotemporal Dementia
Ginkgo biloba
Hallucinations
Humans
Ischemia
Levodopa
Lewy Bodies
N-Methylaspartate
Phenothiazines
Prosencephalon
Psychotic Disorders
Quinacrine
Vitamins
Antipsychotic Agents
Cholinesterase Inhibitors
Cholinesterases
Dihydroergotamine
Levodopa
N-Methylaspartate
Phenothiazines
Quinacrine
Vitamins