The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review and revise its first (2006) Guidelines for clinical practice with anti-
dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A to D, with A having the strongest evidence base (from randomized controlled trials) and D the weakest (case studies or expert opinion). Current clinical diagnostic criteria for
dementia have sufficient accuracy to be applied in clinical practice (B) and brain imaging can improve diagnostic accuracy (B).
Cholinesterase inhibitors (
donepezil,
rivastigmine, and
galantamine) are effective for mild to moderate
Alzheimer's disease (A) and
memantine for moderate to severe
Alzheimer's disease (A). Until further evidence is available other drugs, including
statins, anti-inflammatory drugs,
vitamin E and Ginkgo biloba, cannot be recommended either for the treatment or prevention of
Alzheimer's disease (A). Neither
cholinesterase inhibitors nor
memantine are effective in those with
mild cognitive impairment (A).
Cholinesterase inhibitors are not effective in
frontotemporal dementia and may cause agitation (A), though
selective serotonin reuptake inhibitors may help behavioural (but not cognitive) features (B).
Cholinesterase inhibitors should be used for the treatment of people with Lewy body
dementias (
Parkinson's disease dementia and
dementia with Lewy bodies (DLB)), especially for neuropsychiatric symptoms (A).
Cholinesterase inhibitors and
memantine can produce cognitive improvements in DLB (A). There is no clear evidence that any intervention can prevent or delay the onset of
dementia. Although the consensus statement focuses on medication, psychological interventions can be effective in addition to
pharmacotherapy, both for cognitive and non-
cognitive symptoms. Many novel pharmacological approaches involving strategies to reduce
amyloid and/or tau deposition are in progress. Although results of pivotal studies are awaited, results to date have been equivocal and no disease-modifying agents are either licensed or can be currently recommended for clinical use.