(FDA approved in bold)

• Alzheimer dementia (AD) (mild or moderate)
  
• Dementia with Lewy Bodies (DLB)
  
• Vascular dementia

• Increases the concentration of acetylcholine through reversible inhibition of metabolism by acetylcholinesterase enzyme, which increases availability of acetylcholine. A deficiency of cholinergic function is felt to be important in producing the signs and symptoms of AD
  
• May also modulate nicotine receptors, increasing acetylcholine release
  
• May interfere with amyloid deposition
  
• Although symptoms of AD can improve, galantamine does not prevent disease progression

• Typically 2–6 weeks at a given dose, but effect is best observed over a period of months

• Continue to use but symptoms of dementia usually worsen over time

• Change to another cholinesterase inhibitor or NMDA-antagonist (memantine)
  
• Non-pharmacologic measures are the basis of dementia treatment. Maintain regular schedules and routines. Avoid prolonged travel, unnecessary medical procedures or emergency room visits, crowds, and large social gatherings
  
• Limit drugs with sedative properties such as opioids, hypnotics, antiepileptic drugs and tricyclic antidepressants
  
• Treat other disorders which can worsen symptoms such as hyperglycemia or urinary difficulties

• Addition of the NMDA receptor antagonist memantine may be useful
  
• Treat depression or apathy, if present, with SSRIs. Avoid tricyclic antidepressants in demented patients due to risk of confusion
  
• For significant confusion and agitation avoid neuroleptics (especially in Lewy Body dementia) because of the risk of neuroleptic malignant syndrome. Atypical antipsychotics (risperidone, quetiapine, olanzapine, clozapine) can be used instead

• None required