Clinical Question

Can drug treatments improve outcomes in people with dementia?

Bottom Line

Some treatments can improve cognition on research scales, but daily function will not be affected in a noticeable way. Managing behavioral or psychological issues with medication is not supported by current evidence. (Level of Evidence = 1a)

Synopsis

The authors searched four databases, including the Cochrane Library, a clinical trials database, and bibliographies of other systematic reviews, to identify all English-language studies of drug treatments for cognition, function, or behavioral and psychological symptoms associated with Alzheimer-type dementia. Two authors screened possible articles for inclusion. One author performed data extraction, which was verified by a second author. The authors assessed risk of bias and only analyzed results from studies with low or medium risk, removing 97 of the 163 unique studies they identified. The researchers found a small improvement in cognition (standardized mean difference = 0.30) with a low strength of evidence for cholinesterase inhibitors, although there was no effect on overall function or global clinical impression. The most frequently studied cholinesterase inhibitor was donepezil (Aricept). In patients with moderate to severe disease, adding memantine (Namenda) to a cholinesterase inhibitor improved cognition and overall clinical impression, but not function compared with placebo. No treatments had sufficient evidence of their benefit on behavioral or psychological symptoms. Withdrawal from treatment because of adverse effects was higher with cholinesterase inhibitors galantamine (Razadyne) and rivastigmine (Exelon) compared with placebo. There was not significant heterogeneity among the studies. The likelihood of publication bias was not reported.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Government

Setting: Various (meta-analysis)

Reference: Fink HA, Linskens EJ, MacDonald R, et al. Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia. Ann Intern Med. 2020;172(10):656–668.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.