engleski

Algorithms for pharmacotherapy of dementia

The drug treatment of dementia is always very challenging and it has progressed through various changes in the era of psychopharmacology. The application of cholinesterase inhibitors, like donepezil, implies neuroprotection and resultant slowing of disability and disease progression, while glutamatergic NMDA receptor uncompetitive antagonist memantine may block neural excitotoxicity, which plays a major role in A-beta induced neuronal death. Antidementia drug utilization strategies may vary regionally. Here we rewieved Management of dementia: Report of the Quality Standards Subcomittee of the American Academy of Neurology (2001), Consensus Statement from British Association for Psychopharmacology (2006), Recommendations for Best Practices in the Treatment of Alzheimer Disease in Managed Care (2006) and Croatian Algorithm for Psychopharmacological Treatment of Alzheimer Dementia (2006). Early detection and diagnosis of Alzheimer disease and other dementias is critical to achieve optimal quality of care. Drug monotherapy is always the simplest and safest treatment, but very often multiple medications from different categories may be necessary. Patients with mixed dementia, pure vascular dementia, Levy body dementia and Parkinson dementia may be treated according to Alzheimer disease guidelines. Patients first diagnosed with mild stage Alzheimer disease should be treated with a cholinesterase inhibitor. Memantine is currently not FDA (The Food and Drug Administration ) approved for mild dementia. Patients first diagnosed with moderate stage should be initially treated with a cholinesterase inhibitor and then memantine should be added at least 2 months after cholinesterase inhibitor reaches an optimal doses and adverse effects have been minimized. Patients first diagnosed with severe Alzheimer disease should be treated initially with memantine and combination therapy with cholinesterase inhibitor can be added. Newly diagnosed patients should be re- evaluated within 2 months and then monitored at least every 6 months thereafter. Patients and caregivers should be counseled with regard to «realistic» expectations of antidementia pharmacologic treatment. Patients with all types of dementia comonly suffer from comorbid psychosis and behavioural disturbances that impair their daily functioning, create caregiver and family distress and lead to institutionalization. In April 2005, FDA issued an advisory statement that the treatment of behavioural disorders in elderly persons with dementia with so- called atypical antipsychotic medications is associated with increased mortality, so none of these antipsychotics is approved for the treatment of behavioural disorders in patients with dementia. Accumulating evidence suggests that donepezil and memantine have an antipsychotic potential in addition to their effect upon improvement of cognitive functions.

algorithms ; pharmacotherapy ; dementia

Cited/Abstracted in ExcerptaMedica (EMBASE) ; Psychological abstracts/Psyc INFO ; Chemical Abstracts ; Cambridge Scientific Abstracts/Social Services Abstracts.