American
Academy of Neurology Guidelines
This 2001 practice parameter addresses four clinically relevant questions
regarding the management of dementia and is addressed to neurologists and all
other clinicians who manage patients with dementia.
- Does pharmacotherapy for cognitive symptoms improve outcomes in patients
with dementia compared with no therapy?
- Does pharmacotherapy for noncognitive symptoms improve outcomes in patients
with dementia compared with no therapy?
- Do educational interventions improve outcomes in patients and/or caregivers
of patients with dementia compared with no such interventions?
- Do nonpharmacologic interventions other than education improve outcomes
in patients and/or caregivers of patients with dementia compared with no such
interventions?
The Practice Recommendations for pharmacologic treatment of AD are outlined
below:
- Cholinesterase inhibitors should be considered in patients with mild to
moderate AD, although studies suggest a small average degree of benefit.
- Vitamin E (1000 I.U. PO BID) should be considered in an attempt to slow
progression of AD
- Selegiline (5 mg PO BID) is supported by one study, but has a less favorable
risk– benefit ratio
- There is insufficient evidence to support the use of other antioxidants,
anti inflammatories, or other putative disease-modifying agents specifically
to treat AD because of the risk of significant side effects in the absence
of demonstrated benefits
- Mixed populations or patients with mixed dementias
- Some patients with unspecified dementia may benefit from ginkgo biloba,
but evidence-based efficacy data are lacking
- Ischemic vascular dementia
- There are no adequately controlled trials demonstrating pharmacologic
efficacy for any agent in ischemic vascular (multi-infarct) dementia.
