What medications may be used to reduce the rate of decline in cognitive function and improve behavioral symptoms in patients with mild to moderate dementia?
Cholinesterase inhibitors may reduce the rate of decline in cognitive function and may improve behavioral symptoms. Three agents of this class (donepezil, rivastigmine, and galantamine) are currently approved by the FDA to treat patients with dementia of the Alzheimer’s type. Consider the use of a cholinesterase inhibitor in patients with a diagnosis of dementia who have mild to moderate cognitive and functional decline that is not caused by an underlying treatable condition and in whom drug therapy is not clinically contraindicated. In patients who do not appear to be benefitting from these medications or whose cognition is deteriorating despite treatment, consider discontinuing therapy if no other clear indication exists. Explain the rationale for discontinuing these medications to the patient and involved family members. In some cases, discontinuation may be associated with worsening cognitive and physical function. Memantine hydrochloride (an N-methyl-D-aspartate receptor antagonis
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