Fast Five Quiz: Dementia Key Aspects

Helmi L. Lutsep, MD


May 21, 2020

To date, only symptomatic therapies for Alzheimer disease are available and thus do not act on the evolution of the disease. All drugs approved by the US Food and Drug Administration for the treatment of Alzheimer disease modulate neurotransmitters, either acetylcholine or glutamate. The standard medical treatment for Alzheimer disease includes ChEIs and a partial NMDA antagonist.

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 may slow the progression of vascular dementia. Drug treatment is primarily used to prevent further worsening of vascular dementia by treating the underlying disease, such as hypertension, hyperlipidemia, or diabetes mellitus. Antiplatelet agents are indicated.

Hallucinations and agitation are especially troublesome in Lewy body dementia. When these symptoms are mild, no medical treatment may be necessary. When medication is used, acetylcholinesterase inhibitors should usually be tried first. Cholinesterase inhibitors that may be effective in the treatment of Lewy body dementia include donepezil and galantamine. Atypical neuroleptics, such as clozapine, quetiapine, or aripiprazole, may be indicated if cholinesterase inhibitors are ineffective. Avoid standard neuroleptics, such as haloperidol, because of neuroleptic sensitivity.

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.

Read more about the treatment of Alzheimer disease.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Dementia Pathology, Alzheimer Disease, Vascular Dementia, Lewy Body Dementia, and Frontotemporal Dementia and Frontotemporal Lobar Degeneration.

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