Pharmacological treatment of cognitive dysfunction in dementia disorders.

Dementia represents a complex heterogeneity of disorders. For Alzheimer's disease great progress in the understanding of underlying genetical, neuropathological and neurochemical mechanisms of the disease has been made during recent years. A variety of therapeutic approaches with cognitive enhancing drugs have been tested in Alzheimer patients. Presently, four main treatment strategies prevail, namely transmitter replacement therapy, growth factors, anti-inflammatory drugs and drugs affecting amyloid processing in the brain. The transmitter therapy is so far the most explored and fruitful strategy. The cholinesterase inhibitor tacrine is in clinical use in many countries. Other cholinergic treatment strategies than cholinesterase inhibitors in development are selective muscarinic receptor agonists and nicotine receptor agonists. The selective 5HT re-uptake blockers might be complementary to drugs with more specific effect on cognition. Although treatment with growth factor therapy e.g. nerve growth factor in Alzheimer patients has given some promising results, further research is needed. Development of drugs affecting amyloid processing is still mainly on a preclinical level.