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The American College of Physicians and the American Academy of Family Physicians have published a clinical practice guideline on pharmacologic therapies for dementia. The guideline is based on a review of 59 randomized trials of five FDA-approved drugs (donepezil, galantamine, rivastigmine, tacrine, and memantine) in more than 16,000 patients. The guideline concludes that evidence is insufficient to compare the drugs for effectiveness, and it recommends the following:
Base decisions about starting a cholinesterase inhibitor on individualized assessments.
Base the choice of pharmacologic agent on tolerability, adverse effects, ease of use, and cost.
Further research on effectiveness of the medications alone and in combination for clinical outco…