Dementia
Syndrome of progressive cognitive decline with impaired memory, thinking, orientation, calculation, and learning.
ICD-10 F036 drugs
Also known as: Alzheimer disease, Vascular dementia
Drugs used for this condition
- ARivastigmineFirst line · Acetyl- and butyrylcholinesterase inhibitorDrug of choice for Parkinson's disease dementia per AAN 2024 and the Spanish SEN 2023 consensus. Also effective in dementia with Lewy bodies (off-label in most countries). Advantage over donepezil reflects butyrylcholinesterase activity relevant in these dementia types.
- BDonepezilSecond line · Selective reversible acetylcholinesterase inhibitorIn dementia with Lewy bodies and Parkinson's disease dementia, acetylcholinesterase inhibitors (donepezil, rivastigmine) are used off-label per AAN 2024 to ease cognitive symptoms and psychotic features. Among formally approved EU options for these diagnoses, rivastigmine is more commonly registered.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DHuperzine A (Huperzia serrata)Not recommended · Alkaloid of Chinese club moss (Huperzia serrata, Lycopodium serratum), a selective reversible acetylcholinesterase inhibitor. Registered as a prescription medicine Shuangyiping for Alzheimer disease in China. No marketing authorisation in the EU or USA; sold as a dietary supplementHuperzine A is sometimes recommended for vascular dementia and mixed-type dementia by extrapolation from Alzheimer data. Direct RCTs in vascular dementia outside China are limited; the Yang 2013 systematic review focused on Alzheimer. NICE 2018 (NG97) for vascular dementia lists vascular risk factor control (BP, statins, antiplatelets) first-line; cholinesterase inhibitors are considered in mixed dementia with suspected Alzheimer component. Huperzine A is not in ESC, AHA or NICE vascular and mixed dementia guidelines. If huperzine A was recommended for diagnosed dementia (any subtype) without considering donepezil, rivastigmine or galantamine, consider seeking a second opinion from a neurologist.
- DLion's Mane Mushroom (Hericium erinaceus)Not recommended · Medicinal mushroom; in supplements – dried mycelium or fruiting body of Hericium erinaceus. Marketed on iHerb, Amazon, and in Spanish herbolarios as a «natural nootropic», nerve growth factor (NGF) stimulant, and remedy for dementia, anxiety, and ADHD. AEMPS does not register it as a medicine; AESAN classifies it as a complemento alimenticio without therapeutic indication. FDA has no approved indication.Lion's mane marketing leans on fear of dementia: «protects the brain from Alzheimer's», «restores neurons», «natural memantine». The Mori 2009 RCT is the only available double-blind trial, and it enrolled 30 Japanese adults with MCI, not Alzheimer's disease. The 1.3-point HDS-R effect after 16 weeks with return to baseline after stopping is a weak symptomatic signal, not disease modification. RCTs in patients with established Alzheimer's, vascular, or frontotemporal dementia are absent. NICE NG97 recommends cholinesterase inhibitors (donepezil, rivastigmine, galantamine) in mild-moderate Alzheimer's and memantine in moderate-severe disease; primary prevention runs through blood-pressure, diabetes, and lipid control, smoking cessation, exercise, a Mediterranean diet, hearing-loss management, and social engagement. The WHO Dementia Fact Sheet 2023 and the Alzheimer's Association point out: no «brain health» supplement modifies the course of dementia, and «natural memantine» marketing is unsupported by clinical data. A real risk of lion's mane in suspected dementia is delaying neurologic or geriatric assessment and losing the window when approved drugs still work. If lion's mane was bought for a relative with Alzheimer's, consider seeking a second opinion – NICE NG97 dementia management does not include mushroom supplements.
- FCerebrolysin (porcine brain peptides)Not recommended · Other metabolic agents (local classification)Evidence tier F. Cerebrolysin is not mentioned in the AAN, APA, NICE or EAN dementia guidelines for Alzheimer disease or vascular dementia. A 2017 Cochrane review on cerebrolysin for vascular dementia concluded that data were insufficient to support routine clinical use. Available trials are small, mostly single-centre, sponsored by the manufacturer and report short-term changes on cognitive scales without consistent effects on activities of daily living or institutionalisation. Evidence-based therapy for Alzheimer dementia consists of cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine, which produce modest symptomatic benefit but do not modify disease progression.
- FGinkgo biloba extractNot recommended · Herbal agents for cognitive disordersThe 2009 Cochrane review 'Ginkgo biloba for cognitive impairment and dementia' reported inconsistent results with large effect dispersion and no clinically meaningful cognitive benefit in the most rigorous RCTs. The largest trial, GEM 2008 (3069 participants, 6 years follow-up), found no reduction in dementia risk with EGb 761 240 mg daily. AAN 2018 does not recommend ginkgo for mild cognitive impairment, and NICE NG97 does not mention it for dementia.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit