Authors' objectives: To review the evidence and answer the questions: Does pharmacotherapy for dementia syndromes improve cognitive symptoms and outcomes? Does pharmacotherapy delay cognitive deterioration or delay disease onset of dementia syndromes? Are certain drugs, including alternative medicines (non-pharmaceutical), more effective than others? Do certain patient populations benefit more from pharmacotherapy than others? What is the evidence base for the treatment of ischemic vascular dementia (VaD)?

Authors' results and conclusions: (1) Efficacy: 186 randomized controlled trials (RCTs) evaluated 97 drugs. As expected the findings varied with the dementia population and the specific outcomes in the various domains. Those pharmacological agents that showed a consistent effect of benefit are as follows: A) Global assessment was improved by donepezil, galantamine, rivastigmine, velnacrine, cerebrolysin and idebenone; B) Cognition (general and specific) was improved by donepezil, galantamine, metrifonate (this drug has been withdrawn from use in North America because of safety concerns), nicergoline, physostigmine, rivastigmine, velnacrine, memantine, cerebrolysin, ginkgo biloba, idebenone and propentofylline; C) Behavior/mood was improved by haloperidol; D) Quality of life/Activities of Daily Living (ADL) was improved by donepezil, galantamine and posatirelin. In general, caregiver burden and quality of life/ADL were not frequently evaluated. (2) Delay disease: Cerebrolysin, selegiline plus vitamin E, and donepezil showed some significant effects in delaying disease progress in patients with mild to moderate and moderately severe Alzheimer's disease. (3) Head to head comparisons: Superiority was seen for sulphomucopolysaccharides over CDP-choline, donepezil over vitamin E, antagonic-stress over nicergoline, antagonic-stress over meclofenoxate, posatirelin over citicoline, and pyritinol over hydergine. (4) Patient populations: Stratified analyses included: age, gender, Apolipoprotein E (APOE) genotype, disease type, disease severity, race by location, care dependence, and presence of depression. Single populations of dementia subjects with Down's syndrome, and depression were evaluated. Evidence was inconclusive for this question. (5) Ischemic VaD: A total of 20 pharmacological interventions in 29 studies were applied to vascular dementias. Differences were suggested between multi-infarct dementia (MID) and Alzheimer's disease (AD) for 5'-MTHF-trazodone, AD and VaD for citalopram, and AD and MID for Ginkgo biloba. Trials with VaD patients showed effects for memantine, nicergoline, pentoxyfylline, idebenone, donepezil and cerebrolysin.

Authors' recommendations: Pharmacotherapy for dementia can improve symptoms and outcomes. Adverse events should be more systematically reported. Few studies evaluated delay in either disease onset or progression, but there was some evidence suggesting delay in progression. Few studies compared drugs with other drugs. Due to poor evaluation, data was limited to consider efficacy of pharmacotherapy in different subgroups of patients. Some agents have been shown to be effective in VaD patients.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/dempharmtp.htm

Year Published: 2004

URL for published report: n/a

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)