The use of medications for cognitive enhancement

Objective: To provide Canadian physicians and allied health care profession als with the evidence they need to help them make treatment decisions in th e management of patients with Alzheimer's disease or other dementias. Optio ns: The full range and quality of diagnostic and therapeutic modalities ava ilable to Canadian physicians for the management of dementia. Outcomes: imp rovement in the treatment of dementias, leading to reduced suffering, incre ased functional capacity and decreased economic burden. Evidence and values : The creation of these evidence-based consensus statements involved litera ture reviews of the subject by the authors: comparison of alternative clini cal pathways and description of the methods whereby published data were ana lyzed: definition of the level of evidence for data in each case: evaluatio n and revision in a conference setting (involving primary care physicians, neurologists, psychiatrists, geriatricians, psychologists, consumers and ot her interested parties): insertion of tables showing key variables and data from various studies and tables of data with recommendations: and reassess ment by all authors. Benefits, harms, and costs: A rational plan for the th erapy of dementias is likely to lead to substantial benefits in both human and economic terms. Recommendations: Treatment decisions should be made tak ing into account the severity or stage of the disease, the availability of caregivers, the presence of disease affecting other bodily systems and the ability of the subject to pay the cost of the medications. Donepezil is con sidered to have positive effects upon certain tests of neuropsychological f unction and may produce some improvement in Alzheimer's disease of mild to moderate severity as measured by rating scales. Its ability to improve qual ity of life remains uncertain. No other drug treatments (apart from symptom atic therapies) are at present approved for the treatment of Alzheimer's di sease* Validation: These recommendations were created by a writing committe e, evaluated and revised at a consensus conference and further reviewed and revised by the writing committee prior to publication.