Pharmacologic treatment of dementia and mild cognitive impairment: Critical appraisal

Medications approved for the treatment of dementia remain the target of controversy despite data supporting their utility. Critics argue that their cognitive benefits, which are modest at best, are not a sufficient standard of social desirability to outweigh the associated costs and inconvenience. A comprehensive approach combining behavioral and pharmacologic interventions is widely accepted but data to demonstrate the social significance is lacking. As a result, both clinical practice and public expectations have outstripped the evidence base. Uncertainty about meaningful outcomes can be reduced with studies of new interventions. However, more powerful interventions will almost certainly mean more troublesome side effects. Both social consensus and refined measures of outcome will be required to meet the inevitable controversy over definitions of benefit.