Pharmacological Management

Only symptomatic treatment, there is no cure. Acetylcholinesterase inhibitors - Only for mild to moderate dementia –Donepezil – initially 5 mgs X 4 weeks -> 10 mgs –Rivastigmine – initially 1.5 mgs BID X 4 weeks increase to 3mg BID –Galantamine – initially 4mg X 4 wks increase to 16 to 24 mg NMDA receptor antagonist –Memantine 5mg X 4 weeks, increase to 10 mg.

OFF LABEL DRUGS Amyloid deposit inhibitors –Minocycline and Clioquinoline, antibiotics, may help reduce amyloid deposits in the brains of persons with Alzheimer disease. Antidepressant drugs –Depression is frequently associated with dementia and generally worsens the degree of cognitive and behavioral impairment. Antidepressants effectively treat the cognitive and behavioral symptoms of depression in patients with Alzheimer's disease, but evidence for their use in other forms of dementia is weak.

Selegiline –a drug used primarily in the treatment of Parkinson's disease –Appears to slow the development of dementia. –Acts as an antioxidant, preventing free radical damage. Also acts as a stimulant, that may increase elevation of brain activity Antipsychotic drugs Typical antipsychotics - Haloperidol Atypical antipsychotics - Risperidone –Both types of antipsychotics are known to increase the risk of death in dementia-associated psychosis. –Infrequently used, it is only used when weighing out the risks and benefits thoroughly.