The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review the evidence on the drug treatment for
dementia. The level of evidence (types) was rated using a standard system: Types 1a and 1b (evidence from meta-analysis of randomised controlled trials or at least one controlled trial respectively); types 2a and 2b (one well-designed study or one other type of quasi experimental study respectively); type 3 (non-experimental descriptive studies); and type 4 (expert opinion). There is type 1a evidence for
cholinesterase inhibitors (
donepezil,
rivastigmine and
galantamine) for mild to moderate
Alzheimer's disease;
memantine for moderate to severe
Alzheimer's disease; and for the use of bright
light therapy and
aromatherapy. There is type 1a evidence of no effect of anti inflammatory drugs or
statins. There is conflicting evidence regarding oestrogens, with type 2a evidence of a protective effect of oestrogens but 1b evidence of a harmful effect. Type 1a evidence for any effect of B12 and
folate will be forthcoming when current trials report. There is type 1b evidence for gingko biloba in producing a modest benefit of cognitive function;
cholinesterase inhibitors for the treatment of people with
Lewy body disease (particularly neuropsychiatric symptoms);
cholinesterase inhibitors and
memantine in treatment
cognitive impairment associated with
vascular dementia; and the effect of
metal collating agents (although these should not be prescribed until more data on safety and efficacy are available). There is type 1b evidence to show that neither
cholinesterase inhibitors nor
vitamin E reduce the risk of developing
Alzheimer's disease in people with
mild cognitive impairment; and there is no evidence that there is any intervention that can prevent the onset of
dementia. There is type 1b evidence for the beneficial effects of adding
memantine to
cholinesterase inhibitors, and type 2b evidence of positive switching outcomes from one
cholinesterase inhibitor to another. There is type 2a evidence for a positive effect of reminiscence
therapy, and type 2a evidence that
cognitive training does not work. There is type 3 evidence to support the use of psychological interventions in
dementia. There is type 2 evidence that a clinical diagnosis of
dementia can be made accurately and that brain imaging increases that accuracy. Although the consensus statement dealt largely with medication, the role of
dementia care in secondary services (geriatric medicine and old age psychiatry) and primary care, along with health economics, was discussed. There is ample evidence that there are effective treatments for people with
dementia, and
Alzheimer's disease in particular. Patients, their carers, and clinicians deserve to be optimistic in a field which often attracts therapeutic nihilism.