Medications against dementia in Alzheimer’s and Parkinson's disease

This HTA report investigates the efficacy of various anti-dementia medications for the treatment of dementia symptoms in Alzheimer’s and Parkinson's disease. It also considers safety, the cost/benefit ratio, and legal, social, ethical and organisational aspects.

Literature searches found that in mild to moderate and in some cases also in advanced dementia in Alzheimer’s and Parkinson's disease, the anti-dementia medications used had a certain positive effect, for example on cognitive abilities, compared to placebo. Whether patients perceive this effect is open to question. Considered over a longer period, the cost/benefit ratio for most of the anti-dementia medications was positive. However, these cost/benefit analyses should be treated with caution due to the limited data.

Treatment of dementias involves various legal, social, ethical and organisational aspects. Decisions on taking medications must factor in patient autonomy and consequences for authorised representatives. From an ethical point of view, it should be mentioned that certain studies neglected important factors for those affected, such as mood swings and anxiety. From a legal perspective, the use of anti-dementia medications in disabled individuals is challenging, and from a social point of view, the burden on caregivers should be borne in mind.

According to the report's model calculations, treatment with anti-dementia medications is less expensive that treatment without them. There may be theoretical cost savings if these medications are not used, provided that no additional nursing care is required. Additional costs may also arise as an early transfer to in-patient care must be expected when the patient stops taking the medications.