New Therapeutic Approaches to Cognitive Impairment

Therapeutic approaches to the cognitive impairment of dementia are making their way into clinicalpractice. Clinical pharmacologic approaches toward improvement of cognitive symptoms are discussed,with an emphasis on cholinergic approaches, since they currently appear most promising and since severalcholinesterase inhibitors may soon be available for prescribing. As more knowledge is gained aboutdosing, side effects, and mechanisms of action, these drugs can be prescribed more efficiently. Currentresearch approaches to slowing the rate of cognitive decline are discussed, including the use of antioxidants,monoamine oxidase-B inhibitors, and cholinesterase inhibitors. Drugs that improve cognitionmay also have effects on behavioral symptoms, severe dementia, and non-Alzheimer’s dementia. Evidencesuggests that some dementia patients may be particularly responsive to intervention and that othermedications may enhance response. Psychosocial interventions may also contribute to prolonging thetime to institutionalization