Pharmacotherapy of dementias

Abstract

At present, acetylcholinesterase inhibitors represent the most important antidementative strategy. Patients with mild to moderate Alzheimer's disease should be considered to treat with these substances. According to results of novel studies, they may also be used in severe Alzheimer's disease, Lewy body dementia or vascular dementia. New data confirm that the glutamate antagonist, memantine also belongs to the first line drugs in treatment of severe Alzheimer's disease. Less evidence exists for the use of so-called nootropics, antioxydative drugs, or vitamin E, that are, however, widely prescribed due to their favourable side effect and cost profiles. The general use of non-steroidal anti-inflammatory drugs or statins or the prophylactic substitution of estrogens can not be recommended as long as controlled studies have proven their effectiveness in dementia. In the future, the vaccine against amyloid peptide or inhibitors of secretion and aggregation of Alzheimer amyloid peptide could become the first causal therapies for Alzheimer's disease.