Experimental approaches and drugs in development for the treatment of dementia

Treatment of dementia can be divided as symptomatic treatment of cognitive or non-cognitive symptoms and the treatment of underlying pathology. In the last decade the thrust of symptomatic treatment of Alzheimer's disease (AD ) has been enhancement of cholinergic transmission. Besides the acetylcholi nesterase inhibitors (AChE-I) currently in use, cholinergic agonists and en hancers are in development. Other therapeutic approaches directed towards n eurotransmitter substitution or modulation include serotoninergic, noradren ergic substances, neuropeptides and those acting via excitatory amino acid receptors, such as ampakines or NMDA antagonists. Introduction of atypical neuroleptics represents the most recent development in the treatment of beh avioural symptoms. Efforts to treat the underlying pathology are based on m odulation of APP processing in order to decrease the accumulation of beta - amyloid, those to decrease tau hyperphosphorylation, use of nerve growth fa ctors and those based on Apo-E modulation. Potential use of oestrogens and NSAIDs are also under investigation. Recently, vaccination with amyloid-bet a peptide has been reported to be effective in an animal model of AD, this putative vaccine is now in clinical trials. Likewise, recent studies sugges t that some statins may have a prophylactic effect.