12 - Summary of clinical practice guidance for use

Summary of clinical practice guidance for use of anti-dementia drugs

Prescribing in older people CHAPTER 6 genetics and biomarker analysis, much has been discovered about the phenomena underlying frontotemporal lobar degeneration. This has allowed the design of new molecule-­based therapies that are still in the early stages of research but may show promise.134 A Cochrane review assessed the efficacy and safety of AChE-­Is for rare dementias associated with neurological conditions. The sample sizes of most trials were very small and efficacy on cognitive function was found to be unclear, although AChE-­Is were associated with more gastrointestinal adverse effects than placebo.135 Summary of clinical practice guidance for use of anti-­dementia drugs AChE-­Is and memantine are effective in AD of a broad range of severity. Other drugs including statins, anti-­inflammatory drugs, vitamin E, nutritional supplements and Gingko cannot be recommended either for the treatment or prevention of AD. Neither AChE-­Is nor memantine are effective in MCI. AChE-­Is are not effective in frontotemporal dementia and may cause agitation. AChE-­Is may be used for people with Lewy body dementia (both Parkinson’s disease dementia and DLB), and memantine may be helpful. No drugs are clearly effective in VaD, though AChE-­Is are beneficial in mixed dementia. Early evidence suggests multifactorial interventions may have the potential to prevent or delay the onset of dementia. Many novel pharmacological approaches involving strategies to reduce amyloid and/or tau deposition in those with or at high risk of AD are in progress. Although results of pivotal studies in early (prodromal/ mild) AD are awaited, results to date in more established (mild to moderate) AD have been equivocal and no disease-­modifying agents are either licensed or can be currently recommended for clinical use. Table 6.3 summarises the clinical practice guidelines from BAP.23 Table 6.3  Summary of British Association for Psychopharmacology recommendations. First choice Second choice Alzheimer’s disease AChE-­Is Memantine Vascular dementia None (some benefit with donepezil 10mg – but risk of adverse effects) None Mixed dementia AChE-­Is Memantine Dementia with Lewy bodies AChE-­Is Memantine Mild cognitive impairment None None Dementia with Parkinson’s disease AChE-­Is Memantine Frontotemporal dementia None None AChE-­Is, acetylcholinesterase inhibitors.