Difficulty in Choosing Drugs to Treat Dementia

A group from the American College of Physicians, led by Dr. Amir Qaseem, conducted a review of 96 different studies covering five drugs used to treat dementia. According to the article in Reuters:

"The drugs can sometimes delay progression of the symptoms of dementia, which can take many different forms.

None works very well for people in general, although individual patients may see benefits, Qaseem said.

'There is so much variation between individual patients,' he said. And if doctors keep trying one drug after another, weeks and months can pass. In the end, he said, 'there might not be any effect at all.'

Writing in the Annals of Internal Medicine, Qaseem and colleagues said they looked for evidence that the drugs helped cognition, global function, behavior, mood and quality of life.

Rather than trying to find the most effective drug, doctors should focus on tolerability, adverse effects, ease of use and cost, they recommended."

The drugs reviewed are the only ones currently FDA-approved drugs for treatment of dementia, donepezil (Aricept), galantamine (Razadyne, Reminyl, Nivalin), rivastigmine (Exelon), tacrine, and memantine (Mamenda). The review has led to new guidelines issued by a joint panel of the American Academy of Family Physicians and the American College of Physicians:

Dementia Guideline Panel Recommendations

Recommendation 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment. (Grade: weak recommendation, moderate-quality evidence.)

Recommendation 2: Clinicians should base the choice of pharmacological agents on tolerability, adverse effect profile, ease of use and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacological agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.)

Recommendation 3: There is an urgent need for further research on the clinical effectiveness of pharmacological management of dementias.