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Review
March 4, 2024
David B.Reuben,MD1; SarahKremen,MD2,3; Donovan T.Maust,MD, MS4,5
Author Affiliations Article Information
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1Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles
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2Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
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3Jona Goldrich Center for Alzheimer’s and Memory Disorders, Cedars-Sinai Medical Center, Los Angeles, California
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4Department of Psychiatry, University of Michigan, Ann Arbor
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5Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
JAMA Intern Med. 2024;184(5):563-572. doi:10.1001/jamainternmed.2023.8522
- Viewpoint Longitudinal Management of Dementia in Primary Care
Lauren R.Moo,MD
JAMA Internal Medicine
- JAMA Internal Medicine Patient Page I Am Worried About Memory Loss—What Should I Know?
Tamara G.Fong,MD, PhD; Stephanie S.Buss,MD
JAMA Internal Medicine
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Abstract
Importance Dementia affects 10% of those 65 years or older and 35% of those 90 years or older, often with profound cognitive, behavioral, and functional consequences. As the baby boomers and subsequent generations age, effective preventive and treatment strategies will assume increasing importance.
Observations Preventive measures are aimed at modifiable risk factors, many of which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions of any kind can prevent dementia. Nevertheless, addressing risk factors may have other health benefits and should be considered. Alzheimer disease can be treated with cholinesterase inhibitors, memantine, and antiamyloid immunomodulators, with the last modestly slowing cognitive and functional decline in people with mild cognitive impairment or mild dementia due to Alzheimer disease. Cholinesterase inhibitors and memantine may benefit persons with other types of dementia, including dementia with Lewy bodies, Parkinson disease dementia, vascular dementia, and dementia due to traumatic brain injury. Behavioral and psychological symptoms of dementia are best treated with nonpharmacologic management, including identifying and mitigating the underlying causes and individually tailored behavioral approaches. Psychotropic medications have minimal evidence of efficacy for treating these symptoms and are associated with increased mortality and clinically meaningful risks of falls and cognitive decline. Several emerging prevention and treatment strategies hold promise to improve dementia care in the future.
Conclusions and Relevance Although current prevention and treatment approaches to dementia have been less than optimally successful, substantial investments in dementia research will undoubtedly provide new answers to reducing the burden of dementia worldwide.
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Reuben DB, Kremen S, Maust DT. Dementia Prevention and Treatment: A Narrative Review. JAMA Intern Med. 2024;184(5):563–572. doi:10.1001/jamainternmed.2023.8522
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