Antidementive pharmacotherapy -: an update

Cholinesterase inhibitors of the second generation (donepezil, rivastigmine, galantamine) are considered to be the gold standard in the treatment of mild to moderate severe Alzheimer's disease, even though their advantage to the classical nootropics has not been proved by direct comparison so far. Because of inconsistent results, methodical faults and often insufficiently elucidated pharmacological targets, treatment of cognitive disorders with these substances has often been questioned. Meanwhile however, a number of studies that are in accordance with the modern research criteria document for several nootropics a certain therapeutic effect. The uncompetitive NMDA-antagonist memantine is the only substance that has the admission for the treatment of moderate to severe dementia so far. From the current point of view, it seems to be unlikely that therapeutic efforts that are derived from epidemiological observations (e. g. treatment with NSAR or estrogens) will be new perspectives in the treatment of dementia. However, efforts to diminish oxidative stress, e. g. by radical scavengers or antioxidants, are very promising. Results about combinations of different substances, e. g. a cholinesterase inhibitor and memantine, are not available so far. Antiamyloid therapeutic efforts are substance of current pre-clinical research.