Current Pharmacologic Treatment of Dementia: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians

4 March 2008 | Volume 148 Issue 5 | Pages 370-378

Description: The American College of Physicians and American Academy of Family Physicians developed this guideline to present the available evidence on current pharmacologic treatment of dementia.

Methods: The targeted literature search included evidence related to the effectiveness of 5 U.S. Food and Drug Administration–approved pharmacologic therapies for dementia for outcomes in the domains of cognition, global function, behavior/mood, and quality of life/activities of daily living.

Recommendation 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualized assessment. (Grade: weak recommendation, moderate-quality evidence.)

Recommendation 2: Clinicians should base the choice of pharmacologic agents on tolerability, adverse effect profile, ease of use, and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacologic agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.)

Recommendation 3: There is an urgent need for further research on the clinical effectiveness of pharmacologic management of dementia.

Author and Article Information

From the American College of Physicians and University of Pennsylvania, Philadelphia, Pennsylvania; Medstudy, Colorado Springs, Colorado; University of Arkansas, Little Rock, Arkansas; Veterans Affairs Greater Los Angeles Healthcare System and RAND, Santa Monica, California; The Pennsylvania State University, Hershey, Pennsylvania; University of Missouri-Columbia School of Medicine, Columbia, Missouri; Medical College of Wisconsin, Milwaukee, Wisconsin; American Academy of Family Physicians, Leawood, Kansas; McMaster University, Hamilton, Ontario, Canada; University of Minnesota, Minneapolis, Minnesota; and Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, California.

Clinical Efficacy and Assessment Subcommittee of the American College of Physicians: Douglas K. Owens, MD, MS (Chair); Donald E. Casey Jr., MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Paul Dallas, MD; Nancy C. Dolan, MD; Mary Ann Forciea, MD; Lakshmi Halasyamani, MD; Robert H. Hopkins Jr., MD; and Paul Shekelle, MD, PhD. Commission on Science of the American Academy of Family Physicians: Eric M. Wall, MD, MPH; Jonathan E. Rodnick, MD; Kenneth G. Schellhase, MD, MPH; Steven W. Strode, MD, MEd, MPH; Kurtis S. Elward, MD, MPH; James W. Mold, MD, MPH; Jonathan L. Temte, MD, PhD; Frederick M. Chen, MD, MPH; Thomas F. Koinis, MD; Donya A. Powers, MD; James M. Gill, MD, MPH; Kevin Peterson, MD, MPH; Robert C. Marshall, MD, MPH; Herbert F. Young, MD, MA; and Bellinda K. Schoof, MHA, CPHQ.

Note: Clinical practice guidelines are "guides" only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication, or once an update has been issued.

Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Financial Support: Financial support for the development of this guideline comes exclusively from the American College of Physicians' and American Academy of Family Physicians' operating budgets.

Potential Financial Conflicts of Interest: Honoraria: P. Santaguida (American College of Physicians). Grants received: V. Snow (Centers for Disease Control and Prevention, Novo Nordisk, Bristol-Myers Squibb, Robert Wood Johnson Foundation, Boehringer-Ingelheim, Endo Pharmaceuticals).

Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, aqaseem{at}acponline.org.

Current Author Addresses: Drs. Qaseem and Snow: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Dr. Cross: 1761 South 8th Street, Suite H, Colorado Springs, CO 80906.

Dr. Forciea: 3615 Chestnut Street, Philadelphia, PA 19104.

Dr. Hopkins: 4301 West Markham Street, Suite 641, Little Rock, AR 72205.

Dr. Shekelle: 1776 Main Street, Santa Monica, CA 90401.

Dr. Adelman: 500 University Drive, Hershey, PA 17033.

Dr. Mehr: MA306 Medical Sciences Building DC032.00, Columbia, MO 65212.

Dr. Schellhase: 8701 Watertown Plank Road, Milwaukee, WI 53226.

Dr. Campos-Outcalt: 11400 Tomahawk Creek Parkway, Leawood, KS 66211.

Dr. Santaguida: McMaster University Evidence-based Practice Center, 50 Main Street East, DTC-FLR 3, Hamilton, Ontario L8N 1E9, Canada.

Dr. Owens: 117 Encina Commons, Stanford, CA 94305.

^* This paper, written by Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; J. Thomas Cross Jr., MD, MPH; Mary Ann Forciea, MD; Robert Hopkins Jr., MD; Paul Shekelle, MD, PhD; Alan Adelman, MD; David Mehr, MD, MS; Kenneth Schellhase, MD, MPH; Doug Campos-Outcalt, MD, MPA; Pasqualina Santaguida, PhD; and Douglas K. Owens, MD, MS, was developed for the American College of Physicians' Clinical Efficacy Assessment Subcommittee and the Commission on Science of the American Academy of Family Physicians. For members of these groups, see end of text. Approved by the American College of Physicians' Board of Regents on 16 April 2007. Approved by the American Academy of Family Physicians' Board of Directors on 13 June 2007.

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