Pharmacotherapy for dementia

HyunChul Youn; Hyun-Ghang Jeong

doi:10.5124/jkma.2018.61.12.758

J Korean Med Assoc > Volume 61(12); 2018 > Article

Youn and Jeong: Pharmacotherapy for dementia

Pharmacotherapeutics

J Korean Med Assoc 2018; 61(12): 758-764.

Published online: December 17, 2018

DOI: http://dx.doi.org/10.5124/jkma.2018.61.12.758

Pharmacotherapy for dementia

HyunChul Youn, MD^1,², Hyun-Ghang Jeong, MD^1,²

¹Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

²Korea University Research Institute of Mental Health, Seoul, Korea

Corresponding author: Hyun-Ghang Jeong E-mail: jeonghg@korea.ac.kr

Received November 06, 2018 Accepted November 13, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dementia is a clinical syndrome characterized by a cluster of symptoms and signs that manifest as difficulties in cognitive functions such as memory, psychological and psychiatric changes, and impairments in activities of daily living. As a result of worldwide trends of population aging, dementia has had a huge impact on public health in almost all countries. Disease modification therapies for dementia have not yet been developed. However, pharmacotherapy is essential in patients with dementia to combat delays in their cognitive and functional decline. In this article, we review the current pharmacotherapy for dementia. Three acetylcholinesterase inhibitors—donepezil, rivastigmine, galantamine—and memantine are the only medications that have been approved for the treatment of dementia. We present the indications, dose recommendations, side effects, and criteria for National Health Insurance coverage in Korea of these medications for dementia treatment. Although the Ministry of Food and Drug Safety in Korea has not approved any medications for managing the behavioral and psychological symptoms of dementia, some antipsychotics and antidepressants have been studied and used clinically for those purposes. Clinicians may consider vitamin E, Ginkgo biloba extract, choline alfoscerate, or omega-3 fatty acids as additional treatment options. Non-steroid anti-inflammatory drugs, estrogen hormone therapy, and statins are not generally recommended for dementia treatment. We believe that our findings will aid clinicians in the treatment of patients with cognitive decline.

Key words: Dementia; Pharmacotherapy; Cholinesterase inhibitors; Memantine

Table 1.

Criteria for National Health Insurance coverage in Korea and dose recommendations for acetyl cholinesterase inhibitors and memantine for dementia treatment

	Donepezil	^High-dose donepezil	Rivastigmine	Rivastigmine (patch)	Galantamine	Memantine
Dose recommendation	5-10 mg	23 mg	6-12 mg	5-15 cm²	8-24 mg	5-20 mg
MMSE	≤26	≤20	10-26	≤26	10-26	≤20
CDR	1-2	2-3	1-2	1-3	1-2	2-3
GDS	3-5	4-7	3-5	3-7	3-5	4-7

MMSE, Mini-Mental State Examination; CDR, Clinical Dementia Rating; GDS, Global Deterioration Scale.

Table 2.

General dose recommendations of medications for managing the behavioral and psychological symptoms of dementia

Recommended indication	Medication	General dose recommendation (mg)
Irritability, agitation, aggression	Haloperidol	0.25-12
	Risperidone	0.25-4
	Quetiapine	25-600
	Olanzapine	5-10
	Aripiprazole	2-15
	Oxcarbazepine	300-900
	Fluvoxamine	25-200
	Citalopram	10-40
	Trazodone	50-300
	Sertraline	25-200
Depression	Escitalopram	5-15
	Sertraline	25-150
	Fluoxetine	10-40

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