The British Association for Psychopharmacology coordinated a meeting of experts to review and revise its previous 2011 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-D, with A having the strongest evidence base (from randomised 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 both structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography and single photon emission computerised tomography) brain imaging can improve diagnostic accuracy in particular situations (B).
Cholinesterase inhibitors (
donepezil,
rivastigmine, and
galantamine) are effective for cognition in mild to moderate
Alzheimer's disease (A),
memantine for moderate to severe
Alzheimer's disease (A) and combination
therapy (
cholinesterase inhibitors and
memantine) may be beneficial (B). Drugs should not be stopped just because
dementia severity increases (A). Until further evidence is available other drugs, including
statins, anti-inflammatory drugs,
vitamin E, nutritional supplements 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 (both
Parkinson's disease dementia and
dementia with Lewy bodies), and
memantine may be helpful (A). No drugs are clearly effective in
vascular dementia, though
cholinesterase inhibitors are beneficial in
mixed dementia (B). Early evidence suggests multifactorial interventions may have potential to prevent or delay the onset of
dementia (B). Though 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 in those with or at high risk of
Alzheimer's disease are in progress. Though results of pivotal studies in early (prodromal/mild)
Alzheimer's disease are awaited, results to date in more established (mild to moderate)
Alzheimer's disease have been equivocal and no disease modifying agents are either licensed or can be currently recommended for clinical use.