Current Pharmacologic Treatment of Dementia: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians

TLDR

The guideline summarizes evidence on FDA‑approved pharmacologic therapies for dementia and calls for further research into their clinical effectiveness. The authors performed a targeted literature review of the effectiveness of five FDA‑approved drugs across cognition, global function, behavior/mood, and quality‑of‑life outcomes. Clinicians should initiate cholinesterase inhibitor or memantine trials based on individualized assessment and select agents considering tolerability, side‑effect profile, ease of use, and cost, though evidence is insufficient to compare their effectiveness.

Abstract

Description: The American College of Physicians and American Academy of Family Physicians developed this guideline to present the available evidence on current pharmacologic treatment of dementia. Methods: The targeted literature search included evidence related to the effectiveness of 5 U.S. Food and Drug Administration–approved pharmacologic therapies for dementia for outcomes in the domains of cognition, global function, behavior/mood, and quality of life/activities of daily living. Recommendation 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment. (Grade: weak recommendation, moderate-quality evidence.) Recommendation 2: Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.) Recommendation 3: There is an urgent need for further research on the clinical effectiveness of pharmacologic management of dementia.