Patients with dementia – a challenge for pharmacist

Dementia is an umbrella term that refers to progressive and irreversible cognitive decline. Dementia affects several cognitive domains: memory, language, attention, execution function, perceptual and motor skills, and social networking. Behavioral and psychiatric symptoms complicate dementia, being difficult to manage. Depending on the causes and the clinical presentation, there are several types of dementia. Alzheimer dementia is the most common type, and it is believed to be due to the interneuronal deposition of insoluble beta-amyloid plaques and intraneuronal neurofibrillary tangles consisting of tau protein, which eventually lead to neuronal destructions with cholinergic deficiency. The medicines currently used in Alzheimer disease therapy are cholinesterase inhibitors and NMDA receptor antagonists. These drugs are not disease modifiers and do not address the cause; they act symptomatic-pathogenically, slowing down cognitive decline. Psychiatric and behavioral symptoms associated with dementia are treated with appropriate medication. From the therapeutic regimen of patients with Alzheimer disease it is preferable to eliminate drugs with anticholinergic and sedative effects.