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AAN Publishes Dementia Treatment Guidelines

Kate Traynor

New dementia management guidelines from the American Academy of Neurology propose a range of options for prescribers to consider when treating patients who have Alzheimer’s disease or a similar disorder.

The guidelines, which were released in May, do not put forward a specific plan for therapy but instead offer recommendations based on the academy’s review of scientific literature on the treatment of dementia.

Among the academy’s recommendations is the use of cholinesterase inhibitors to treat mild to moderate Alzheimer’s disease. Physicians are also advised to consider oral vitamin E supplementation—1,000 units per day—for slowing the progression of Alzheimer’s disease.

Selegiline, a stereoselective inhibitor of monoamine oxidase (MAO), is described as having a "less favorable risk-benefit ratio" than vitamin E for Alzheimer’s patients and is not directly recommended. The guidelines advise against using selegiline in combination with vitamin E for treating Alzheimer’s. The academy’s literature review did not reveal enough evidence to support the use of other antioxidants, anti-inflammatory drugs, or estrogens to prevent the progression of Alzheimer’s disease.

In addition to discussing drug therapy for Alzheimer’s disease, the academy reviewed the use of antipsychotic and antidepressant drugs in patients with this condition. Antipsychotic drugs are recommended for patients whose symptoms have not responded to "environmental manipulation." The guidelines note that, compared with "traditional" medications, "atypical" antipsychotic agents are often better tolerated by patients with Alzheimer's disease.

The academy does not recommend the use of anticonvulsants, benzodiazepines, antihistamines, MAO inhibitors, or selective serotonin-reuptake inhibitors (SSRIs) to treat agitation or psychotic episodes in Alzheimer’s patients. MAO-B inhibitors and SSRIs are, however, recommended as therapy for patients with depression and Alzheimer’s disease.