Which medications are used to treat patients with cognitive impairment?

Updated: Dec 02, 2020
  • Author: Claudia L Reardon, MD; more...
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Answer

Answer

No medications are used in the process of screening for cognitive impairment. However, if dementia is diagnosed, medications may be used to treat the symptoms of the condition or to slow down progression of it. The following are among the most common medications that may be used: [21]

  • Cholinesterase inhibitors (tacrine, donepezil, rivastigmine, and galantamine): These medications are approved for use in mild, moderate, or severe Alzheimer disease and are sometimes also used for other types of dementia (for example, vascular dementia or mixed dementias). These medications may produce small, temporary improvements in cognition or functioning or temporarily slow down cognitive decline.

  • Memantine: This medication is an N-methyl-D-aspartate receptor antagonist. It is approved to treat moderate to severe Alzheimer disease. Additionally, memantine together with a cholinesterase inhibitor is a combination sometimes used in moderate to severe Alzheimer disease. The clinical effect of memantine is like that of the cholinesterase inhibitors in that it may result in temporary benefit but does not change the long-term course of the disorder.

  • Other medications that may be used to manage the symptoms of dementia include antidepressants/anxiolytics (eg, fluoxetine, sertraline, paroxetine, citalopram), antipsychotics (eg, haloperidol, risperidone, quetiapine, olanzapine, ziprasidone), and anticonvulsants (eg, valproic acid, carbamazepine, gabapentin, lamotrigine). However, none of these are specifically FDA-approved for use in dementia. Furthermore, atypical antipsychotics have a black box warning stating that their use in elderly patients with dementia-related psychosis is associated with an increased risk of death compared to placebo. Most such deaths appear to be either cardiovascular (eg, heart failure, sudden cardiac death) or infectious (eg, pneumonia) in nature. The decision to use atypical antipsychotics in patients with dementia must involve a careful weighing of potential risks and benefits.


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