Dementia subtype therapy reference (2026)

Dementia therapy in 2026 organises by subtype and by stage.

Alzheimer's disease: cholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild-to-moderate disease; memantine for moderate-to-severe. Anti-amyloid antibodies (lecanemab, donanemab) in early Alzheimer's disease with amyloid-positive status (covered in earlier rounds). Brexpiprazole for agitation in Alzheimer's dementia (covered in mental health round 7).

Dementia with Lewy bodies (DLB): cholinesterase inhibitors are first-line and often very effective in DLB, more so than in Alzheimer's. Antipsychotics are typically avoided due to severe sensitivity reactions in DLB; when needed, low-dose pimavanserin or quetiapine are preferred. Levodopa for parkinsonian features at lower doses than in pure Parkinson's.

Vascular dementia: management is primarily aimed at controlling cardiovascular risk factors (blood pressure, lipids, diabetes, smoking, atrial fibrillation). Cholinesterase inhibitors and memantine have variable benefit.

Frontotemporal dementia (FTD): supportive care is the foundation; SSRIs are used off-label for behavioural symptoms, antipsychotics with caution. Late-stage programs include progranulin-replacement therapy for GRN-mutation FTD, ASO programs for C9orf72-mutation FTD-ALS, and tau-targeted programs.

The diagnostic-pathway question matters across subtypes. Modern diagnosis combines clinical features, structural imaging (MRI), functional imaging (FDG-PET, amyloid-PET, tau-PET, DAT-SPECT for DLB), cerebrospinal fluid biomarkers, blood-based biomarkers (plasma p-tau and others, expanding rapidly), and (in selected cases) genetic testing. Specialist evaluation is increasingly important as therapy decisions become subtype-specific.