[Advances in Anti-Dementia Therapies in Older Adults]

The rising prevalence of dementia, driven by demographic aging, underscores the urgent need for effective therapeutic strategies. This update reviews recent advances in anti-dementia treatments, focusing on pharmacological and non-pharmacological interventions. Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the NMDA receptor agonist memantine, traditionally used for Alzheimer's disease, are now recommended off-label for vascular dementia, offering modest cognitive benefits with manageable side effects. The approval of amyloid-targeting monoclonal antibodies - lecanemab and donanemab - marks a paradigm shift, as these agents demonstrate disease-modifying potential in mild cognitive impairment (MCI) and early Alzheimer's disease by reducing amyloid plaques and slowing cognitive decline. However, their use is complicated by amyloid-related imaging abnormalities (ARIA), necessitating careful patient selection and monitoring, particularly in APOE4 homozygotes. Non-pharmacological approaches, including cognitive and physical training, have gained prominence. Regular moderate exercise (150 minutes/week) improves cognitive function in MCI and dementia, while multimodal interventions (e.g., FINGER, POINTER) target risk reduction through lifestyle modifications. Digital health applications, such as "Neuronation" and "Memodio", offer promising adjuncts, though evidence remains limited. The failure of GLP-1 analogs (e.g., semaglutide) in recent trials highlights the challenges in repurposing metabolic agents for neurodegeneration. The introduction of disease-modifying therapies emphasizes the importance of early diagnosis and comprehensive geriatric assessment to balance efficacy, safety, and patient-centered outcomes. Ongoing research and real-world data will further clarify the long-term benefits and risks of these innovations, shaping future dementia care.