Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline

@article{Raina2008EffectivenessOC,
  title={Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline},
  author={Parminder Raina and Pasqualina Santaguida and Afisi S Ismaila and Christopher Patterson and David Cowan and Mitch Levine and Lynda Booker and Mark Oremus},
  journal={Annals of Internal Medicine},
  year={2008},
  volume={148},
  pages={379-397}
}
Dementias have become a major public health concern because of their increasing prevalence, chronicity, caregiver burden, and high personal and financial costs of care. Currently, there are no cures for most dementias. For the most common types (Alzheimer disease, vascular dementia, and mixed dementias), clinicians often prescribe pharmacotherapy to alleviate symptoms and delay disease progression. The pharmacotherapeutic agents available to treat problems associated with dementias (for example… 
Pharmacotherapy for dementia : a review of cholinesterase inhibitors and memantine
TLDR
The rationale behind the use of ChEI and memantine for AD, their efficacy and adverse, and their combined use in other types of dementia are discussed.
Pharmacological treatment of dementia
TLDR
Recent systematic clinical reviews and new research on currently available treatment options provide valuable assistance for clinicians to deal with frequent clinical problems in the context of dementia.
Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review
TLDR
The diverse aspects of AChEIs, including the mechanisms of action, characteristics and risk factors of ADRs, and preventive strategies of their ADRs are recapitulate and update.
Cholinesterase inhibitors for co-morbid Alzhemer’s disease dementia and schizophrenia: Systematic review and meta-analysis
TLDR
There is a very limited evidence on the efficacy and safety of using acetylcholinesterase inhibitors in the management of dementia co-morbid with schizophrenia and the only randomised controlled study shows lack of evidence in terms of efficacy.
Pharmacotherapy for Dementia: A Practical Approach to the Use of Cholinesterase Inhibitors and Memantine
  • C. Wong
  • Psychology, Medicine
    Drugs & Aging
  • 2016
TLDR
Evidence-based recommendations are provided to address the issues regarding the use of cholinesterase inhibitors and memantine in clinical practice, which includes their efficacy, timing, assessment, use in institutionalized patients, combined use, and use in other dementia types.
Persistence of Cholinesterase Inhibitor Treatment in Dementia: Insights from a Naturalistic Study
TLDR
Maintenance of the first prescribed ChEI was supported when some benefit was perceived by the patient or caregiver, even in cases of nonserious adverse events, including Alzheimer's disease or Lewy body dementia.
A Systematic Review and Meta-Analysis of the Effectiveness of Acetylcholinesterase Inhibitors and Memantine in Treating the Cognitive Symptoms of Dementia
TLDR
AChEIs demonstrate a modest effect versus control on MMSE scores which is moderated by dementia subtype, and for memantine the effect is smaller.
Effectiveness of Adding Memantine to an Alzheimer Dementia Treatment Regimen Which Already Includes Stable Donepezil Therapy: A Critically Appraised Topic
TLDR
The addition of memantine to donepezil in patients with moderate-to-severe AD provides a statistically significant improvement in several AD-oriented outcome measures, however, the clinical relevance of this benefit remains unclear.
The Use of Cholinesterase Inhibitors Across All Stages of Alzheimer’s Disease
TLDR
Patients should be regularly monitored for any potential serious side effects of ChEI therapy, which also may include syncope and bradycardia, and attempts to cautiously discontinue all medications not necessary for quality of life, including AD drugs, should be made.
Alternative drug therapies for dementia.
  • R. Howland
  • Medicine, Biology
    Journal of psychosocial nursing and mental health services
  • 2011
TLDR
There is no evidence that other drug therapies, including vitamin E, selegiline, nonsteroidal anti-inflammatory drugs, statin drugs, omega-3 fatty acids, estrogen or combined estrogen plus progestin therapy, or B vitamins, are sufficiently effective and safe to justify their clinical use for the treatment of dementing disorders.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 173 REFERENCES
Utility of the Mattis dementia rating scale to assess the efficacy of rivastigmine in dementia associated with Parkinson’s disease
TLDR
Rivastigmine has a beneficial effect on cognitive function in PDD, and the Mattis dementia rating scale was able to detect this improvement and could be considered as an interesting outcome measure in further work.
Memantine for dementia.
TLDR
The beneficial effect on cognition in patients with mild to moderate vascular dementia was not detectable on global assessment at six months and the statistical significance of these benefits could be overturned by data from two unpublished studies which are known to show no significant effect.
Rivastigmine for dementia associated with Parkinson's disease.
TLDR
Rivastigmine was associated with moderate improvements in dementia associated with Parkinson's disease but also with higher rates of nausea, vomiting, and tremor; however, the differences between these two groups were moderate and similar to those reported in trials of rivastIGmine for Alzheimer's disease.
Memantine for dementia.
TLDR
A small beneficial effect of memantine at six months in moderate to severe AD is suggested and the statistical significance of these benefits could be overturned by data from two unpublished studies which are known to show no significant effect.
Efficacy and tolerability of memantine in the treatment of dementia.
Donepezil for vascular cognitive impairment.
  • R. Malouf, J. Birks
  • Medicine, Psychology
    The Cochrane database of systematic reviews
  • 2004
TLDR
The clinical efficacy and tolerability of donepezil on cognitive function, clinical global impression, activities of daily living and social functioning of people with vascular cognitive impairment was well tolerated and most of the side effects were transient and were resolved by stopping the medication.
Depression and Alzheimer's disease: Symptom or comorbidity?
TLDR
Findings indicate that depressive symptoms, if specifically treated, tend to reduce caregiver stress and improve well-being in patients with Alzheimer's disease, and that SSRI intake seems to be effective for depression, decreasing it and improving quality of life for both patients and caregivers.
Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis.
TLDR
It is indicated that cholinesterase inhibitors have a modest beneficial impact on neuropsychiatric and functional outcomes for patients with AD and future research should focus on how such improvements translate into long-term outcomes such as patient quality of life, institutionalization, and caregiver burden.
...
1
2
3
4
5
...