Skip to main content
SpringerLink
Log in

Pharmacological Management of Dementia—An Overview

  • Chapter
  • First Online:
Dementia Care

  • 770 Accesses

Abstract

The medical management and pharmacotherapy of dementia are at interesting crossroads. There have been many recent developments with newer drugs being developed that would probably halt the progression of dementia. The following review looks at the various options we currently have in the pharmacotherapy of dementia and provides an overview of these drugs for the busy clinician. It also looks at the future and various newer drugs that would be developed and be available in the next decade. The future of the pharmacotherapy of dementia is promising with many new drugs in the pipeline.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Atri, A., Molinuevo, J. L., Lemming, O., Wirth, Y., Pulte, I., & Wilkinson, D. (2013). Memantine in patients with Alzheimer’s disease receiving donepezil: New analyses of efficacy and safety for combination therapy. Alzheimer’s Research Theraphy, 5(1), 6.

    Article  CAS  Google Scholar 

  • Baum, L., Lam, C. W., Cheung, S. K., Kwok, T., Lui, V., Tsoh, J., Lam, L., Leung, V., Hui, E., Ng, C., & Woo, J. (2008). Six-month randomized, placebo-controlled, double-blind, pilot clinical trial of curcumin in patients with Alzheimer disease. Journal of Clinical Psychopharmacology, 28(1), 110–113.

    Article  PubMed  Google Scholar 

  • Birks, J., Evans, J. G. (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev, 1. (CD003120)

    Google Scholar 

  • Birks, J., Harvey, R. J. (2006). Donepezil for dementia due to Alzheimer's disease. Cochrane Database Systematic Reviews, 1. (CD001190)

    Google Scholar 

  • Burns, A., Rossor, M., Hecker, J., Gauthier, S., Petit, H., Möller, H. J., Rogers, S. L., & Friedhoff, L. T. (1999). The effects of donepezil in Alzheimer’s disease—Results from a multinational trial. Dementia and Geriatric Cognitive Disorders, 10(3), 237–244.

    Article  CAS  PubMed  Google Scholar 

  • Clegg, A., Bryant, J., Nicholson, T., McIntyre, L., De Broe, S., Gerard, K., & Waugh, N. (2001). Clinicial and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer’s disease: A rapid and systematic review. Health Technology Assessment, 5(1), 1–37.

    PubMed  Google Scholar 

  • Cohen, S. A., & Mutter, W. E. (1993). Effects of piracetam on N-methyl-D-aspartate receptor properties in the aged mouse brain. Pharmacology, 47(4), 217–222.

    Article  CAS  PubMed  Google Scholar 

  • Collerton, D. (1986). Cholinergic function and intellectual decline in Alzheimer’s disease. Neuroscience, 19(1), 1–28.

    Article  CAS  PubMed  Google Scholar 

  • Colombres, M., Sagal, J. P., & Inestrosa, N. C. (2004). An overview of the current and novel drugs for Alzheimer’s disease with particular reference to anti-cholinesterase compounds. Current Pharmaceutical Design, 10(25), 3121–3130.

    Article  CAS  PubMed  Google Scholar 

  • Coyle, J., & Kershaw, P. (2001). Galantamine, a cholinesterase inhibitor that allosterically modulates nicotinic receptors: Effects on the course of Alzheimer’s disease. Biological Psychiatry, 49(3), 289–299.

    Article  CAS  PubMed  Google Scholar 

  • Danysz, W., & Parsons, C. G. (2003). The NMDA receptor antagonist memantine as a symptomatological and neuroprotective treatment for Alzheimer’s disease: Preclinical evidence. International Journal of Geriatric Psychiatry, 18(S1), S23-32.

    Article  PubMed  Google Scholar 

  • DeKosky, S. T., Williamson, J. D., Fitzpatrick, A. L., Kronmal, R. A., Ives, D. G., Saxton, J. A., Lopez, O. L., Burke, G., Carlson, M. C., Fried, L. P., & Kuller, L. H. (2008). Ginkgo biloba for prevention of dementia: A randomized controlled trial. JAMA, 300(19), 2253–2262.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Doody, R. S., Stevens, J. C., Beck, C., Dubinsky, R. M., Kaye, J. A., Gwyther, L. M., Mohs, R. C., Thal, L. J., Whitehouse, P. J., DeKosky, S. T., & Cummings, J. L. (2001). Practice parameter: Management of dementia (an evidence-based review) Report of the quality standards subcommittee of the American academy of neurology. Neurology, 56(9), 1154–1166.

    Article  CAS  PubMed  Google Scholar 

  • Eagger, S. A., & Harvey, R. J. (1995). Tacrine and other anticholinesterase drugs in dementia. Current Opinion in Psychiatry, 8(4), 264–267.

    Article  Google Scholar 

  • Eagger, S. A., Levy, R., & Sahakian, B. J. (1991). Tacrine in Alzheimer’s disease. Lancet, 337(8748), 989–992.

    Article  CAS  PubMed  Google Scholar 

  • Ernst, E., & Pittler, M. H. (1999). Ginkgo biloba for dementia. Clinical Drug Investigation, 17(4), 301–308.

    Article  Google Scholar 

  • Farlow, M., Gracon, S. I., Hershey, L. A., Lewis, K. W., Sadowsky, C. H., Dolan-, J., Asher, S. W., Beaver, C., Hamilton, D., Bergman, S. M., & Roger, L. F. (1992). A controlled trial of tacrine in Alzheimer’s disease. JAMA, 268(18), 2523–2529.

    Google Scholar 

  • Farlow, M., Anand, R., Messina, J., Jr., Hartman, R., & Veach, J. (2000). A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer’s disease. European Neurology, 44(4), 236–241.

    Article  CAS  PubMed  Google Scholar 

  • Fischhof, P. K., Saletu, B., Rüther, E., Litschauer, G., Möslinger-Gehmayr, R., & Herrmann, W. M. (1992). Therapeutic efficacy of pyritinol in patients with senile dementia of the Alzheimer type (SDAT) and multi-infarct dementia (MID). Neuropsychobiology, 26(1–2), 65–70.

    Article  CAS  PubMed  Google Scholar 

  • Francis, P. T. (2003). Glutamatergic systems in Alzheimer’s disease. International Journal of Geriatric Psychiatry, 18(S1), S15-21.

    Article  PubMed  Google Scholar 

  • Francis, P. T., Palmer, A. M., Snape, M., & Wilcock, G. K. (1999). The cholinergic hypothesis of Alzheimer’s disease: A review of progress. Journal of Neurology, Neurosurgery and Psychiatry, 66(2), 137–147.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ghosh, A. K., Brindisi, M., & Tang, J. (2012). Developing β-secretase inhibitors for treatment of Alzheimer’s disease. Journal of Neurochemistry, 120, 71–83.

    Article  CAS  PubMed  Google Scholar 

  • Gouliaev, A. H., & Senning, A. (1994). Piracetam and other structurally related nootropics. Brain Research Reviews, 19(2), 180–222.

    Article  CAS  PubMed  Google Scholar 

  • Greig, N. H., Ruckle, J., Comer, P., Brownell, L., Holloway, H. W., Flanagan, J., Douglas, R., Canfield, C. J., & Burford, R. G. (2005). Anticholinesterase and pharmacokinetic profile of phenserine in healthy elderly human subjects. Current Alzheimer Research, 2(4), 483–492.

    Article  CAS  PubMed  Google Scholar 

  • Gupta, S. C., Kismali, G., & Aggarwal, B. B. (2013). Curcumin, a component of turmeric: From farm to pharmacy. BioFactors, 39(1), 2–13.

    Article  CAS  PubMed  Google Scholar 

  • Heiss, W. D., Kessler, J., Mielke, R., Szelies, B., & Herholz, K. (1994). Long-term effects of phosphatidylserine, pyritinol, and cognitive training in Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 5(2), 88–98.

    Article  CAS  Google Scholar 

  • Heutink, P. (2000). Untangling tau-related dementia. Human Molecular Genetics, 9(6), 979–986.

    Article  CAS  PubMed  Google Scholar 

  • Ho, Y. S., So, K. F., & Chang, R. C. (2011). Drug discovery from Chinese medicine against neurodegeneration in Alzheimer’s and vascular dementia. Chinese Medicine, 6(1), 15.

    Article  PubMed  PubMed Central  Google Scholar 

  • Howard, R., McShane, R., Lindesay, J., Ritchie, C., Baldwin, A., Barber, R., Burns, A., Dening, T., Findlay, D., Holmes, C., & Hughes, A. (2012). Donepezil and memantine for moderate-to-severe Alzheimer’s disease. New England Journal of Medicine, 366(10), 893–903.

    Article  CAS  PubMed  Google Scholar 

  • Hynd, M. R., Scott, H. L., & Dodd, P. R. (2004). Glutamate-mediated excitotoxicity and neurodegeneration in Alzheimer’s disease. Neurochemistry International, 45(5), 583–595.

    Article  CAS  PubMed  Google Scholar 

  • Jayaprakasha, G. K., Rao, L. J., & Sakariah, K. K. (2006). Antioxidant activities of curcumin, demethoxycurcumin and bisdemethoxycurcumin. Food Chemistry, 98(4), 720–724.

    Article  CAS  Google Scholar 

  • Jesky, R., & Hailong, C. (2011). Are herbal compounds the next frontier for alleviating learning and memory impairments? An integrative look at memory, dementia and the promising therapeutics of traditional Chinese medicines. Phytotherapy Research, 25(8), 1105–1118.

    Article  PubMed  Google Scholar 

  • Kurosawa, M., Sato, A., & Sato, Y. (1989). Stimulation of the nucleus basalis of Meynert increases acetylcholine release in the cerebral cortex in rats. Neuroscience Letters, 98(1), 45–50.

    Article  CAS  PubMed  Google Scholar 

  • Lim, G. P., Chu, T., Yang, F., Beech, W., Frautschy, S. A., & Cole, G. M. (2001). The curry spice curcumin reduces oxidative damage and amyloid pathology in an Alzheimer transgenic mouse. Journal of Neuroscience, 21(21), 8370–8377.

    Article  CAS  PubMed  Google Scholar 

  • Ma, X., Tan, C., Zhu, D., Gang, D. R., & Xiao, P. (2007). Huperzine A from Huperzia species—An ethnopharmacolgical review. Journal of Ethnopharmacology, 113(1), 15–34.

    Article  CAS  PubMed  Google Scholar 

  • Mantle, D., Pickering, A. T., & Perry, E. K. (2000). Medicinal plant extracts for the treatment of dementia. CNS Drugs, 13(3), 201–213.

    Article  Google Scholar 

  • Mishra, S., & Palanivelu, K. (2008). The effect of curcumin (turmeric) on Alzheimer’s disease: An overview. Annals of Indian Academy of Neurology, 11(1), 13–19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moretti, A., Gorini, A., F Villa, R. (2011). Pharmacotherapy and prevention of vascular dementia. CNS Neurological Disorders Drug Targets, 10(3), 370–390.

    Google Scholar 

  • Morgan, D. (2011). Immunotherapy for Alzheimer’s disease. Journal of Internal Medicine, 269(1), 54–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nagaraja, D., & Jayashree, S. (2001). Randomized study of the dopamine receptor agonist piribedil in the treatment of mild cognitive impairment. American Journal of Psychiatry, 158(9), 1517–1519.

    Article  CAS  PubMed  Google Scholar 

  • Nicholson, C. D. (1990). Pharmacology of nootropics and metabolically active compounds in relation to their use in dementia. Psychopharmacology (berl), 101(2), 147–159.

    Article  CAS  Google Scholar 

  • Nicolaus, B. J. (1982). Chemistry and pharmacology of nootropics. Drug Development Research, 2(5), 463–474.

    Article  CAS  Google Scholar 

  • Nunan, J., & Small, D. H. (2000). Regulation of APP cleavage by α-, β-and γ-secretases. FEBS Letters, 483(1), 6–10.

    Article  CAS  PubMed  Google Scholar 

  • Olin, JT., Schneider, L. (2002). Galantamine for alzheimer’s disease. Cochrane Database Systematic Reviews, 3. (CD001747)

    Google Scholar 

  • Panza, F., Frisardi, V., Imbimbo, B. P., Capurso, C., Logroscino, G., Sancarlo, D., Seripa, D., Vendemiale, G., Pilotto, A., & Solfrizzi, V. (2010). γ-Secretase inhibitors for the treatment of Alzheimer’s disease: The current state. CNS Neuroscience & Therapeutics, 16(5), 272–284.

    Article  CAS  Google Scholar 

  • Patel, L., & Grossberg, G. T. (2011). Combination therapy for Alzheimer’s disease. Drugs and Aging, 28(7), 539–546.

    Article  CAS  PubMed  Google Scholar 

  • Peretti, C. S., Gierski, F., & Harrois, S. (2004). Cognitive skill learning in healthy older adults after 2 months of double-blind treatment with piribedil. Psychopharmacology (berl), 176(2), 176–182.

    Article  CAS  Google Scholar 

  • Perry, E., & Howes, M. J. (2011). Medicinal plants and dementia therapy: Herbal hopes for brain aging ? CNS Neuroscience & Therapeutics, 17(6), 683–698.

    Article  Google Scholar 

  • Polinsky, R. J. (1998). Clinical pharmacology of rivastigmine: A new-generation acetylcholinesterase inhibitor for the treatment of Alzheimer’s disease. Clinical Therapeutics, 20(4), 634–647.

    Article  CAS  PubMed  Google Scholar 

  • Potkin, S. G., Anand, R., Fleming, K., Alva, G., Keator, D., Carreon, D., Messina, J., Wu, J. C., Hartman, R., & Fallon, J. H. (2001). Brain metabolic and clinical effects of rivastigmine in Alzheimer’s disease. International Journal of Neuropsychopharmacology, 4(3), 223–230.

    Article  CAS  PubMed  Google Scholar 

  • Rogawski, M. A., & Wenk, G. L. (2003). The neuropharmacological basis for the use of memantine in the treatment of Alzheimer’s disease. CNS Drug Reviews, 9(3), 275–308.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rösler, M., Bayer, T., Anand, R., Cicin-Sain, A., Gauthier, S., Agid, Y., Dal-, P., Stähelin, H. B., Hartman, R., & Gharabawi, M. (1999). Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: International randomised controlled trial commentary: Another piece of the Alzheimer’s jigsaw. BMJ, 318(7184), 633–640.

    Google Scholar 

  • Salomone, S., Caraci, F., Leggio, G. M., Fedotova, J., & Drago, F. (2012). New pharmacological strategies for treatment of Alzheimer’s disease: Focus on disease modifying drugs. British Journal of Clinical Pharmacology, 73(4), 504–517.

    Article  CAS  PubMed  Google Scholar 

  • Shishodia, S., Sethi, G., & Aggarwal, B. B. (2005). Curcumin: Getting back to the roots. Annals. New York Academy of Sciences, 1056(1), 206–217.

    Article  CAS  Google Scholar 

  • Sierpina, V. S., Wollschlaeger, B., & Blumenthal, M. (2003). Ginkgo biloba. American Family Physician, 68(5), 923–926.

    PubMed  Google Scholar 

  • Singh, N., Pandey, B. R., & Verma, P. (2011). An overview of phytotherapeutic approach in prevention and treatment of Alzheimer’s syndrome & dementia. International Journal of Pharmaceutical Sciences and Drug Research, 3(3), 162–172.

    Google Scholar 

  • Small, D. H. (2005). Acetylcholinesterase inhibitors for the treatment of dementia in Alzheimer’s disease: Do we need new inhibitors ? Expert Opinion on Emerging Drugs, 10(4), 817–825.

    Article  CAS  PubMed  Google Scholar 

  • Sonkusare, S. K., Kaul, C. L., & Ramarao, P. (2005). Dementia of Alzheimer’s disease and other neurodegenerative disorders—Memantine, a new hope. Pharmacological Research, 51(1), 1–7.

    Article  CAS  PubMed  Google Scholar 

  • Soudamini, K. K., Unnikrishnan, M. C., Soni, K. B., & Kuttan, R. (1992). Inhibition of lipid peroxidation and cholesterol levels in mice by curcumin. Indian Journal of Physiology and Pharmacology, 36, 239–242.

    CAS  PubMed  Google Scholar 

  • Spillantini, M. G., & Goedert, M. (1998). Tau protein pathology in neurodegenerative diseases. Trends in Neurosciences, 21(10), 428–433.

    Article  CAS  PubMed  Google Scholar 

  • Standridge, J. B. (2004). Pharmacotherapeutic approaches to the treatment of Alzheimer’s disease. Clinical Therapeutics, 26(5), 615–630.

    Article  CAS  PubMed  Google Scholar 

  • Takeda, A., Loveman, E., Clegg, A., Kirby, J., Picot, J., Payne, E., & Green, C. (2006). A systematic review of the clinical effectiveness of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in Alzheimer’s disease. International Journal of Geriatric Psychiatry, 21(1), 17–28.

    Article  CAS  PubMed  Google Scholar 

  • Tamayev, R., & D’Adamio, L. (2012). Inhibition of γ-secretase worsens memory deficits in a genetically congruous mouse model of Danish dementia. Molecular Neurodegeneration, 7(1), 19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tariot, P. N., Farlow, M. R., Grossberg, G. T., Graham, S. M., McDonald, S., Gergel, I. (2004). Memantine Study Group. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA, 291(3), 317–324.

    Google Scholar 

  • Tariska, P., & Paksy, A. (2000). Cognitive enhancement effect of piracetam in patients with mild cognitive impairment and dementia. Orvosi Hetilap, 141(22), 1189–1193.

    CAS  PubMed  Google Scholar 

  • Waegemans, T., Wilsher, C. R., Danniau, A., Ferris, S. H., Kurz, A., & Winblad, B. (2002). Clinical efficacy of piracetam in cognitive impairment: A meta-analysis. Dementia and Geriatric Cognitive Disorders, 13(4), 217–224.

    Article  CAS  PubMed  Google Scholar 

  • Wang, Y., Huang, L. Q., Tang, X. C., & Zhang, H. Y. (2010). Retrospect and prospect of active principles from Chinese herbs in the treatment of dementia. Acta Pharmacologica Sinica, 31(6), 649–664.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Whitehouse, P. J., Price, D. L., Struble, R. G., Clark, A. W., Coyle, J. T., & Delon, M. R. (1982). Alzheimer’s disease and senile dementia: Loss of neurons in the basal forebrain. Science, 215(4537), 1237–1239.

    Article  CAS  PubMed  Google Scholar 

  • Wilcock, G., Howe, I., Coles, H., Lilienfeld, S., Truyen, L., Zhu, Y., Bullock, R., & Kershaw, P. (2003). A long-term comparison of galantamine and donepezil in the treatment of Alzheimer’s disease. Drugs and Aging, 20(10), 777–789.

    Article  CAS  PubMed  Google Scholar 

  • Xu, Z. Q., Liang, X. M., Zhang, Y. F., Zhu, C. X., & Jiang, X. J. (2012). Treatment with Huperzine A improves cognition in vascular dementia patients. Cell Biochemistry and Biophysics, 62(1), 55–58.

    Article  CAS  PubMed  Google Scholar 

  • Yamada, K., & Nabeshima, T. (2000). Animal models of Alzheimer’s disease and evaluation of anti-dementia drugs. Pharmacology Therapeutics, 88(2), 93–113.

    Article  CAS  PubMed  Google Scholar 

  • Yang, F., Lim, G. P., Begum, A. N., Ubeda, O. J., Simmons, M. R., Ambegaokar, S. S., Chen, P. P., Kayed, R., Glabe, C. G., Frautschy, S. A., & Cole, G. M. (2005). Curcumin inhibits formation of amyloid β oligomers and fibrils, binds plaques, and reduces amyloid in vivo. Journal of Biological Chemistry, 280(7), 5892–5901.

    Article  CAS  PubMed  Google Scholar 

  • Zhang, H. Y., Zheng, C. Y., Yan, H., Wang, Z. F., Tang, L. L., Gao, X., & Tang, X. C. (2008). Potential therapeutic targets of huperzine A for Alzheimer’s disease and vascular dementia. Chemico-Biological Interactions, 175(1–3), 396–402.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India

    Reetika Dikshit, Sagar Karia, Abha Thakurdesai, Heena Merchant & Avinash De Sousa

Authors
  1. Reetika Dikshit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sagar Karia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abha Thakurdesai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heena Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Avinash De Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Sociologist, Gerontologist and Health Social Scientist, Independent Freelance International/National Consultant and Writer, New Delhi, Delhi, India

    Mala Kapur Shankardass

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dikshit, R., Karia, S., Thakurdesai, A., Merchant, H., De Sousa, A. (2021). Pharmacological Management of Dementia—An Overview. In: Shankardass, M.K. (eds) Dementia Care. Springer, Singapore. https://doi.org/10.1007/978-981-16-3864-0_22

Download citation

  • DOI: https://doi.org/10.1007/978-981-16-3864-0_22

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-3863-3

  • Online ISBN: 978-981-16-3864-0

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation