Treatment for Milder Cognitive Syndromes | The Four Pillars of Dementia Care | Disease Therapies | Therapies for Cognitive Symptoms | Therapies for Neuropsychiatric Symptoms | Supportive Care for Patients | Supportive Care for Caregivers
Given the increased public awareness of dementia, memory clinics
and primary care physicians anecdotally report that patients are
presenting with increasingly milder cognitive symptoms to request
diagnosis and treatment. At present, there is little empirical knowledge
about how to manage these patients clinically; most experts recommend
continued observation, the use of nonpharmacological therapies such
as exercise and mental activity, and possibly cognitive rehabilitation.
The results of at least one randomized trial suggest that the cholinesterase
inhibitor donepezil may delay progression to dementia, especially
in patients who are APOE*E4 carriers
(Petersen et al. 2005), but this has not been replicated
or supported by other trials (Rosenberg et al. 2006).
Initiation of pharmacological therapy is reserved for cases for
which there is strong evidence of likely benefit—for example,
when the patient appears to be about to transition to Alzheimer's
dementia. For more a detailed approach to this issue, see Rosenberg et al. (2006).