Clinical Practice Guidelines for Dementia: Recommendations for Cholinesterase Inhibitors and Memantine
- Author:
Yeshin KIM
1
;
Dong Woo KANG
;
Geon Ha KIM
;
Ko Woon KIM
;
Hee-Jin KIM
;
Seunghee NA
;
Kee Hyung PARK
;
Young Ho PARK
;
Gihwan BYEON
;
Jeewon SUH
;
Joon Hyun SHIN
;
YongSoo SHIM
;
YoungSoon YANG
;
Yoo Hyun UM
;
Seong-il OH
;
Sheng-Min WANG
;
Bora YOON
;
Sun Min LEE
;
Juyoun LEE
;
Jin San LEE
;
Jae-Sung LIM
;
Young Hee JUNG
;
Juhee CHIN
;
Hyemin JANG
;
Miyoung CHOI
;
Yun Jeong HONG
;
Hak Young RHEE
;
Jae-Won JANG
;
Author Information
- Publication Type:Original Article
- From:Dementia and Neurocognitive Disorders 2025;24(1):1-23
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:and Purpose: This clinical practice guideline provides evidence-based recommendations for treatment of dementia, focusing on cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists for Alzheimer’s disease (AD) and other types of dementia.
Methods:Using the Population, Intervention, Comparison, Outcomes (PICO) framework, we developed key clinical questions and conducted systematic literature reviews. A multidisciplinary panel of experts, organized by the Korean Dementia Association, evaluated randomized controlled trials and observational studies. Recommendations were graded for evidence quality and strength using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
Results:Three main recommendations are presented: (1) For AD, cholinesterase inhibitors (donepezil, rivastigmine, galantamine) are strongly recommended for improving cognition and daily function based on moderate evidence; (2) Cholinesterase inhibitors are conditionally recommended for vascular dementia and Parkinson’s disease dementia, with a strong recommendation for Lewy body dementia; (3) For moderate to severe AD, NMDA receptor antagonist (memantine) is strongly recommended, demonstrating significant cognitive and functional improvements. Both drug classes showed favorable safety profiles with manageable side effects.
Conclusions:This guideline offers standardized, evidence-based pharmacologic recommendations for dementia management, with specific guidance on cholinesterase inhibitors and NMDA receptor antagonists. It aims to support clinical decision-making and improve patient outcomes in dementia care. Further updates will address emerging treatments, including amyloid-targeting therapies, to reflect advances in dementia management.
