Pharmacological Treatment of Cognitive and Behavioral Disorders in Dementia

Abstract

Dementia (major neurocognitive disorder according to the DSM-5) is a syndrome characterized by a decline in one or more cognitive domains that interferes with independence in everyday activities. The incidence of dementia increases exponentially with increasing age. Dementia and cognitive impairment are the most relevant contributors to disability and dependence among older people worldwide. Moreover, behavioral disturbances are common in people with major neurocognitive disorder and cause significant impairment in quality of life and healthcare outcomes. Based on the etiology, there are several subtypes of dementia. There are no disease-modifying therapies approved for dementia; management is currently based on the treatment of neurological and neuropsychiatric symptoms in order to improve the quality of life of patients and their caregivers. The recommended treatment strategy includes symptomatic pharmacological therapy of cognitive deficits, cognitive rehabilitation; environmental adaptations, nonpharmacological and pharmacological treatment of behavioral symptoms, and prevention and treatment of complications. Monoclonal antibodies against beta-amyloid are being tested in patients with mild Alzheimer’s disease (AD), in individuals with early cognitive impairment, and in preclinical patients (with autosomal dominant AD mutations and without cognitive symptoms). Only three drugs are licensed for behavioral disorders in dementia: risperidone for short-term treatment of persistent aggression in moderate-to-severe AD, pimavanserin (only in the USA), and clozapine for hallucinations and delusions associated with Parkinson’s disease (PD) psychosis. Maximal duration of antipsychotic treatment should be limited, the duration of the treatment should not exceed 3 months due to an increased risk of mortality, and regular reassessment of the therapy is necessary.