Post: Should Older Adults Be Screened for Cognitive Impairment?

Emerging Treatments for Dementia

The currently approved and marketed drug therapies for dementia, the acetylcholinesterase inhibitors (donepezil, rivastigmine, and galantamine), benefit AD patients’ cognitive functioning in both short-term (6 months) and longer-term (12-36 months) studies, and the cumulative effect of improvements in behavior, everyday function, and caregiver burden reported for each of these agents can be demonstrated in delay in nursing home placement. As additional studies are completed, the value of cholinesterase inhibitors in the treatment of non-AD cognitive disorders, including mild cognitive impairment and prodromal AD, vascular and Lewy body dementias, cognitive impairment associated with Parkinson disease, multiple sclerosis, and perhaps other conditions, is becoming apparent as well. The novel medication memantine is expected to have similar benefits through an entirely different mechanism of action, and it is possible that the combination of memantine with cholinesterase inhibitor therapy will significantly improve overall treatment efficacy. Seventeen drugs, either new agents or familiar medications in novel formulations or indications, are in active development as cognitive enhancers as of 2002. [ 2 ]

Cognitive impairment, while the hallmark of dementias, is only one target for drug therapy. A large body of clinical and research literature documents the value of psychotropic medications in managing the common behavioral and psychological symptoms of dementias, including depression, anxiety, agitation, psychosis, sleep disturbances, and aggressive behaviors.

Medscape General Medicine. 2004;6(1):e48 © 2004 Medscape

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Underdetection of Dementia in Primary Care Practice

The great majority, perhaps upwards of 80%, of all medical care for dementia occurs in primary care settings, including doctors’ offices, hospitals, and nursing homes; specialists initiate treatment for dementia in only about 15% of cases. [ 3 ] Among elderly outpatients, many cases go undiagnosed and, among patients whose dementia is recognized, fewer than one quarter are treated; overall, only about 10% to 15% of all patients receive an acetylcholinesterase inhibitor. [ 4 ] General practitioners consider detection of dementia desirable, but few screen patients unless impairment is already apparent. Waiting for symptoms of dementia to become obvious delays the diagnosis, often by several years, […]

Should Older Adults Be Screened for Cognitive Impairment?