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Current management tactics for patients with dementia

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Dementia develops as a result of continuous long-term progression of less severe cognitive impairment (CI). Social and psychological methods (neurocognitive stimulation and neurocognitive training) are the mainstay of treatment for dementia. At the moment, there are no drugs both to cure dementia and to stop the degeneration of nerve tissue. Modern pharmacotherapy for dementia aims to maintain cognitive functions in the patient for as long as possible and to slow down disability, thus ensuring higher living standards. CI therapy most often consists of compensation for cognitive defect. Among the whole variety of pharmacological agents, the effective drugs to treat dementia are only two groups, such as acetylcholinesterase inhibitors and N-methyl-D-aspartate (NMDA) glutamate receptor antagonists. Atypical neuroleptics are employed for the treatment of psychotic disorders; antidepressants from a group of selective serotonin reuptake inhibitors are for depression. Cognitive behavioral therapy and cognitive stimulation deserve special attention. A high educational level and physical, social, and intellectual and activities can prevent dementia. 

About the Authors

A. V. Medvedeva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Contact: Anastasia Vladimirovna Medvedeva 

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Moscow 119021 


O. V. Kosivtsova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Moscow 119021 

K. A. Makhinov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Moscow 119021 


1. Edhag O, Aguero-Eklund H, Almkvist O, et al, editors. Dementia – Etiology and Epidemiology. Vol. 1. Mö lnlycke: Elanders Infologistics Vä st AB; 2008. 514 p.

2. Cummings J, Lee G, Mortsdorf T, et al. Alzheimer's disease drug development pipeline: 2017. Alzheimers Dement (N Y). 2017 May 24;3(3): 367-384. doi: 10.1016/j.trci.2017.05.002. eCollection 2017 Sep.

3. Yakhno NN, Preobrazhenskaya IS. Alzheimer's disease: pathogenesis, clinic, treatment. Russkii meditsinskii zhurnal. 2002;(10): 1143-6. (In Russ.).

4. Di Carlo A, Baldereschi M, Amaducci L, et al. Incidence of Dementia, Alzheimer's Disease, and Vascular Dementia in Italy. The ILSA Study. J Am Geriatr Soc. 2002 Jan;50(1):41-8.

5. Gavrilova SI. Mental disorders in primary degenerative (atrophic) processes. V kn.: Tiganov AS, redaktor. Rukovodstvo po psikhiatrii [Manual on psychiatry]. Vol. 2. Moscow: Meditsina; 1999. P. 57-117.

6. Levin OS. Relationship between depression and dementia in elderly. Lechenie nervnykh boleznei. 2008;(3):3-9. (In Russ.).

7. Vatolina MA, Samorodskaya IV, Boitsov SA. Lost years of life and death as a result of Alzheimer's disease in Russia. Psikhiatriya. 2014;(1):49-54. (In Russ.).

8. Samorodskaya IV, Andreev EM, Zarat'yants OV, et al. Cerebrovascular disease mortality rates in the population over 50 years of age in Russia and the USA over a 15-year period. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(2): 15-24. (In Russ.). Doi: 10.14412/2074-2711-2017-2-15-24

9. Gavrilova SI. Farmakoterapiya bolezni Al'tsgeimera [Pharmacotherapy of Alzheimer's disease]. Moscow: Pul's; 2003. 337 p.

10. Almkvist O, Basun H, Backman L, et al. Mild cognitive impairment – an early stage of Alzheimer's disease? J Neural Transm Suppl. 1998;54:21-9.

11. Pitkä lä KH, Pö ysti MM, Laakkonen ML, et al. Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial. JAMA Intern Med. 2013 May 27; 173(10):894-901. doi: 10.1001/jamainternmed.2013.359.

12. Dysken MW, Sano M, Asthana S, et al. Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAMAD VA cooperative randomized trial. JAMA. 2014 Jan 1;311(1):33-44. doi: 10.1001/jama. 2013.282834.

13. Adler G, Brassen S. Short-term rivastigmine treatment reduces EEG slow-wave power in Alzheimer patients. Neuropsychobiology. 2001; 43(4):273-6.

14. Londos E, Passant U, Brun A. Regional cerebral blood flow and EEG in clinically diagnosed dementia with Lewy bodies and Alzheimer's disease. Arch Gerontol Geriatr. 2003 May-Jun;36(3):231-45.

15. Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-tosevere Alzheimer's disease. N Engl J Med. 2012 Mar 8;366(10):893-903. doi: 10.1056/NEJMoa 1106668.

16. Lu S, Hill J, Fillit H. Impact of donepezil use in routine clinical practice on health care costs in patients with Alzheimer's disease and related dementias enrolled in a large medicare managed care plan: a case-control study. Am J Geriatr Pharmacother. 2005 Jun;3(2):92-102.

17. Raina P, Santaguida P, Ismaila A, et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med. 2008 Mar 4;148(5):379-97.

18. Roshchina IF, Gavrilova SI, Zharikov GA. Evaluation of the effectiveness of acatinol memantine therapy in patients with Alzheimer's disease by neuropsychological study. Psikhiatriya i psikhofarmakologiya. 2002;(6):230-1. (In Russ.).

19. Howard R, McShane R, Lindesay J, 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. Epub 2015 Oct 27.

20. Pollock BG, Mulsant BH, Rosen J, et al. Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry. 2002 Mar;159(3):460-5.

21. Pollock BG, Mulsant BH, Rosen J, et al. A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatr Psychiatry. 2007 Nov;15(11): 942-52. Epub 2007 Sep 10.

22. Seitz DP, Adunuri N, Gill SS, et al. Antidepressants for agitation and psychosis in dementia// Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008191. doi: 10.1002/14651858.CD008191.pub2.

23. Auchus AP, Bissey-Black C. Pilot study of haloperidol, fluoxetine, and placebo for agitation in Alzheimer's disease. J Neuropsychiatry Clin Neurosci. 1997 Fall;9(4):591-3.

24. Gaber S, Ronzoli S, Bruno A, Biagi A. Sertraline versus small doses of haloperidol in the treatment of agitated behavior in patients with dementia. Arch Gerontol Geriatr Suppl. 2001;7:159-62.

25. Sultzer DL, Gray KF, Gunay I, et al. A double-blind comparison of trazodone and haloperidol for treatment of agitation in patients with dementia. Am J Geriatr Psychiatry. 1997 Winter;5(1):60-9.

26. Porsteinsson AP, Drye LT, Pollock BG, et al. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014 Feb 19;311(7):682-91. doi: 10.1001/jama.2014.93.

27. FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses. 391.htm

28. Liu Z, Chen QL, Sun YY. Mindfulness training for psychological stress in family caregivers of persons with dementia : a systematic review and meta –analysis of randomized control trials. Clin Interv Aging. 2017 Sep 22;12: 1521-1529. doi: 10.2147/CIA.S146213. eCollection 2017.

29. Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562. doi: 10.1002/14651858.CD005562.pub2.

30. Öhman H, Savikko N, Strandberg TE, et al. Effects of Exercise on Cognition: The Finnish Alzheimer Disease Exercise Trial: A Randomized, Controlled Trial. J Am Geriatr Soc. 2016 Apr; 64(4):731-8. doi: 10.1111/jgs.14059. Epub 2016 Apr 1.

31. Graff MJ, Vernooij-Dassen MJ, Thijssen M, et al. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ. 2006 Dec 9; 333(7580):1196. Epub 2006 Nov 17.

32. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA. 2003 Oct 15;290(15): 2015-22.

33. Parfenov VA, Zakharov VV, Preobrazhenskaya IS. Kognitivnye rasstroistva [Cognitive disorders]. Moscow: Remedium; 2014. P. 87-102.


For citations:

Medvedeva A.V., Kosivtsova O.V., Makhinov K.A. Current management tactics for patients with dementia. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(2):102-108. (In Russ.)

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ISSN 2074-2711 (Print)
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