Cognitive Continuum: Areas of Controversy with Cognitive Enhancers

Abstract

Acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists are the only drugs approved by the US Food and Drug Administration for the treatment of Alzheimer's dementia. These drugs have demonstrated only modest efficacy for cognitive improvement and progression delay. Given the lack of alternative therapies and the evidence for early pathophysiologic disruptions in cholinergic neurotransmission, cognitive enhancer use in intermediate states (such as mild cognitive impairment) has become an area of study. Further along the cognitive continuum, clinicians face clinical decision-making challenges when using these medications for even mild or moderate stages of dementia, where one must weigh the potentially modest return in benefit versus the significant adverse risks. In addition, ongoing controversy exists regarding continuation or discontinuation of cognitive enhancers in late or end-stage dementia. These medications have also demonstrated some efficacy for use outside of Alzheimer's dementia, and they may have a clinically beneficial effect in treating other forms of dementia. [ Psychiatr Ann . 2016;46(2):110–117.]