Mailbox Response

The question was submitted 26 September 2009

Subject: Treatment Options

What do you think is the best treatment options available currently for Dementia?

Answer from DementiaNet

I suppose the question pertains to drug treatments for dementia, so before going further into drug treatment options, I want to emphasise that drugs are only part of the overall management of persons with dementia.  Non-drug approaches to treatment as well as empowering family carers with training, education and support are just as important.

The medical evidence is best for drug treatment of Alzheimer's Disease (AD).  There are currently 2 categories of  FDA approved drugs, acetylcholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) and NMDA antagonists (Memantine).  The severity of AD can guide the choice of drugs.  Acetylcholinesterase inhibitors are indicated in mild to moderate AD  although there is now data to support their use in severe dementia as well.  On the other hand, the NMDA antagonist Memantine is indicated for treatment of moderate to severe AD and likewise, there are studies that demonstrate its efficacy in early dementia.  A person with early stage AD could be first treated with an acetylcholinesterase inhibitor and subsequently when his disease progresses despite the drug, he could be switched to Memantine or Memantine could be added on top of the acetyl cholinesterase inhibitor ie. combination therapy.  There are recent studies which suggest that combination therapy works better than either single agent alone.

Both these classes of drugs can also be used in the treatment of vascular dementia while the acetylcholinesterases, in particular Donepezil and Rivastigmine, are also indicated in the treatment of Dementia with Lewy Bodies and Parkinson's Disease Dementia.

The answer was published on DementiaNet 05 October 2009