(p. 997) Pharmacological interventions in mild cognitive impairment and dementia 

Alzheimer’s disease (AD) and other dementias are a major public health concern in many countries because of population ageing. The aetiologic causes of most of the dementias are unknown and recent pharmacological interventions are based on hypotheses such as the ‘amyloid cascade hypothesis’ for AD. Drugs can be divided between symptomatic treatments and disease-modifying drugs. So far regulatory authorities have only approved choline esterase inhibitors (ChEIs) and memantine in AD. It is postulated that the brain lesions in this disease occur 10–15 years before the first clinical signs. New clinical trials are now also including patients with mild cognitive impairment, a stage which often precedes dementia. Primary and secondary outcomes incorporate neuropsychological evaluations but also biomarker assessments such as positon emission tomography (PET) imaging and cerebrospinal fluid (CSF) measurements. This chapter focuses on current available therapies and recent or ongoing clinical trials in mild cognitive impairment and dementias.