Kim Yeshin, Kang Dong Woo, Kim Geon Ha, Kim Ko Woon, Kim Hee-Jin, Na Seunghee, Park Kee Hyung, Park Young Ho, Byeon Gihwan, Suh Jeewon, Shin Joon Hyun, Shim YongSoo, Yang YoungSoon, Um Yoo Hyun, Oh Seong-Il, Wang Sheng-Min, Yoon Bora, Lee Sun Min, Lee Juyoun, San Lee Jin, Lim Jae-Sung, Jung Young Hee, Chin Juhee, Jang Hyemin, Choi Miyoung, Hong Yun Jeong, Rhee Hak Young, Jang Jae-Won
Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.
Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Dement Neurocogn Disord. 2025 Jan;24(1):1-23. doi: 10.12779/dnd.2025.24.1.1. Epub 2025 Jan 20.
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.
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.
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.
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.
本临床实践指南为痴呆症治疗提供循证建议，重点关注用于治疗阿尔茨海默病（AD）及其他类型痴呆症的胆碱酯酶抑制剂和N-甲基-D-天冬氨酸（NMDA）受体拮抗剂。
我们采用人群、干预措施、对照、结局（PICO）框架制定关键临床问题并进行系统文献综述。由韩国痴呆症协会组织的多学科专家小组对随机对照试验和观察性研究进行了评估。使用推荐分级、评估、制定与评价（GRADE）方法对推荐意见的证据质量和强度进行分级。
提出三项主要建议：（1）对于AD，基于中等质量证据，强烈推荐使用胆碱酯酶抑制剂（多奈哌齐、卡巴拉汀、加兰他敏）来改善认知和日常功能；（2）对于血管性痴呆和帕金森病痴呆，有条件推荐使用胆碱酯酶抑制剂，对于路易体痴呆则强烈推荐；（3）对于中度至重度AD，强烈推荐使用NMDA受体拮抗剂（美金刚），其可显著改善认知和功能。这两类药物均显示出良好的安全性，副作用可控。
本指南为痴呆症管理提供了标准化的、基于证据的药物治疗建议，特别是关于胆碱酯酶抑制剂和NMDA受体拮抗剂的具体指导。其旨在支持临床决策并改善痴呆症护理中的患者结局。未来更新将涵盖包括靶向淀粉样蛋白疗法在内的新兴治疗方法，以反映痴呆症管理方面的进展。
