Dementia Treatment

Posted On February 13, 2020

Mild to moderate dementia.

  • MINI MENTAL STATUS EXAM 10-26
  • = Aricept 5 then, 10 mg qd generic $10/month
    • or may use 23 mg generic $55/m.
    • evidence does not support a clinically important advantage to the higher dose and it is associated with increased side effects
  • Rivastigmine (Exelon) 1.5, 3, 4.5, 6 bid generic tab about $30/m
  • = Exelon patch 4.6, 9.5, 13.3 patch about $125/m, generic
    • Efficacy similar
  • Above may cause nausea, bradycardia, rhabdomyolysis
  • Vit E 2000 iu qd, do not use with Namenda
  • Selegiline: efficacy limited
  • Aducanumab

Moderate to severe dementia

  • Mini mental status exam < 17
  • = Consider Namenda (Memantine) 10 mg bid
    • cost $25/m
  • = Namenda xr 28 mg, $90/month
  • May be combined with Aricept 10 mg qd

Aricept can also be used in:

  • Dementia with parkinson disease
  • Lewy body dementia
  • Traumatic brain injury
  • vascular dementia with comorbid alzheimer disease

Dementia with Behavioral problem

  • No FDA approved treatment available
  • SSRI
    • Use Citalopram (Celexa) 20, not to exceed 20 mg
    • Sertraline (Zoloft) 50, 100
  • atypical neuroleptic, use is controversial
    • abilify 2, 5, 10, 20 mg qd
    • Seroquel: Starting dose 50 mg half to 1 hs, titrate up
      • generic available: comes in 25, 50, 100, 200, 300, 400

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