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Cognitive Enhancers, When to Start, What to Expect, When to Stop

Posted Jan 4th, 2021

Cognitive Enhancers, When to Start, What to Expect, When to Stop

This article is a little bit different - it's an overview of the cognitive enhancers - mediations that we use to treat the symptoms of dementia.  The video portion of this article is from a lecture that I gave to a group of medical professionals who work in Geriatrics, and some of the terms and some of the data that I present and discuss might be a little bit hard to understand if you don't have a medical background.

If that's you, check out this article that covers what you need to know if you or your family member is considering starting a dementia medication.

The cognitive enhancers have been around for over 20 years, and fall into 2 categories:

  • Cholinesterase inhibitors (Donepezil, Galanthamine, Rivastigmine)
  • NMDA antagonists (Memantine)

*Note that these medications might be known by slightly different names in other parts of the world, but in Canada and the US, these are the generic names.

Any of these agents are indicated for use in Dementia due to Alzheimer's disease, Dementia with Lewy Bodies, Parkinson's related dementia, and sometimes Vascular dementia or mixed dementia.  Memantine can be used alone or in combination with a cholinesterase inhibitor (CI).  Generally, they are well tolerated but have a discontinuation rate between 5 and 25 percent, largely depending on whether the study of the mediation was industry-sponsored or post marketing.

Here are some of the scientific studies I mentioned in the article:

Memantine for dementia Cochrane Database Syst Rev. 2019 Mar 20;3(3):CD003154. Authors: Rupert McShane et.al.

Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINO-AD) trial: secondary and post-hoc analyses Lancet Neurol. 2015 Dec;14(12):1171-81. doi: 10.1016/S1474-4422(15)00258-6 Authors :: Robert Howard, et.al.

Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev. 2018 Jun 18;6(6):CD001190. doi: 10.1002/14651858.CD001190.pub3. Authors: Jacqueline S Birks , Richard J Harvey.

As always, please leave a comment below if you have any questions or a story you'd like to share.

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