Therapeutic options in dementia

Dementia is the final common path of various pathogenetic mechanisms that may lead to a number of different clinical forms, with primary degenerative and vascular dementias accounting for more than 80% of cases. Dementia is a complex clinical condition that includes cognitive, personality, and behavioral changes. Therefore a therapeutic approach to dementia should be based from the beginning on a comprehensive intervention plan, both pharmacological and nonpharmacological. This should not be aimed at obtaining a complete (impossible) recover but at achieving the best day-to-day management of a chronic, progressive, disabling disease involving numerous domains and showing impairments with varying rates of progression. Deterioration in functional abilities of daily living has a major impact on the quality of life of those suffering from dementia, and this is a critical predictor for institutionalization. Increasingly necessary for optimizing intervention strategies are studies to: (a) measure changes in functional abilities over the course of dementia (namely Alzheimer's disease), (b) evaluate the relationship between functional abilities and cognition, and (c) quantify the effect of various therapeutic approaches on functional decline. Symptomatic drugs affecting cognitive abilities and psychoactive drugs for behavioral disturbances should be considered. For the cognitive domain positive results have been obtained with acetylcholinesterase inhibitors. Among the psychoactive drugs indicated for behavioral disorders, significant improvement in terms of both efficacy and tolerability can be expected from the use of new antipsychotic drugs.