[Drug treatment of emotional and cognitive dysfunction in dementia]

The evaluation, treatment and care of patients with dementia are major tasks for the health service. This paper provides an overview of drug treatment of the emotional and cognitive disturbances of dementia. Tricyclic and the newer anti-depressive agents are effective in patients with dementia and depression. Dopamine-blocking agents are effective for some patients with dementia and psychosis, but their use is limited by frequent and severe side-effects. Atypical neuroleptics may prove useful for this patient group. Aggression and agitation may be treated with serotonergic agents, neuroleptics, or benzodiazepines, but other strategies may also be useful. Cholinesterase-inhibitors have demonstrated efficacy on cognition and function, and may reduce the likelihood of institutionalization. Studies of possible stabilization therapies, such as trophic factors, propentophylline, and antiamyloid drugs, are reviewed. Recent reports suggesting a possible prophylactic effect of antioxidants, oestrogen, and antiinflammatory drugs are discussed. The substantial efforts now being made to discover effective drugs for dementia suggest that compounds that delay the disease progression may be available in the next 5-10 years.