Fast Five Quiz: Dementia

Helmi L. Lutsep, MD


October 17, 2018

Hallucinations and agitation are especially troublesome in DLB. When these symptoms are mild, no medical treatment may be necessary. When medication is used, acetylcholinesterase inhibitors usually should be tried first. For example, double-blinded, placebo-controlled studies have demonstrated that the cholinesterase inhibitor rivastigmine may decrease psychiatric symptoms associated with DLB, particularly apathy, anxiety, hallucinations, and delusions.

A study by Breitner and colleagues showed that NSAIDs do not protect against Alzheimer dementia, at least in the very elderly population. Relying on computerized pharmacy dispensing records and biennial dementia screening, these investigators found that incidence was increased in heavy NSAID users. These findings may represent deferral of Alzheimer disease symptoms from earlier to later old age.

The mainstay of management of vascular dementia is the prevention of new strokes. This includes administering antiplatelet drugs and controlling major vascular risk factors. Aspirin has also been found to slow the progression of vascular dementia.

Neurotransmitter-based treatments, analogous to the use of dopaminergic agents in Parkinson disease or anticholinesterase agents in Alzheimer disease, have not proven beneficial in frontotemporal lobe dementia. There is not a clear rationale for use of anticholinesterase drugs such as donepezil, rivastigmine, or galantamine because no definite cholinergic deficiency is recognized in frontotemporal dementia; however, these drugs are widely used. Anecdotally, they may improve memory but may worsen behavioral symptoms.

For more on the treatment of DLB, read here.


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