Dement Neurocogn Disord.
2025 Jan;24(1):1-23. 10.12779/dnd.2025.24.1.1.
Clinical Practice Guidelines for Dementia: Recommendations for Cholinesterase Inhibitors and Memantine
- Kim Y
1 - Kang DW2
- Kim GH3
- Kim KW4
- Kim HJ5
- Na S6
- Park KH7
- Park YH8
- Byeon G2
- Suh J9
- Shin JH10
- Shim Y11
- Yang Y12
- Um YH13
- Oh Si14
- Wang SM15
- Yoon B16
- Lee SM17
- Lee J18
- Lee JS14
- Lim JS19
- Jung YH20
- Chin J21
- Jang H22
- Choi M23
- Hong YJ24
- Rhee HY25
- Jang JW1
- on behalf of Korean Dementia Association
- Affiliations
-
- 1Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
- 2Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 3Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- 4Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
- 5Department of Neurology, Hanyang University Hospital, College of Medicine, Hanyang University, Seoul, Korea
- 6Department of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- 7Department of Neurology, College of Medicine, Gachon University Gil Medical Center, Incheon, Korea
- 8Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 9Department of Neurology, National Medical Center, Seoul, Korea
- 10Dr Shin’s Neurology Clinic, Wonju, Korea
- 11Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- 12Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea
- 13Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 14Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
- 15Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 16Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 17Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
- 18Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
- 19Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 20Department of Neurology, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
- 21Department of Psychology, Doheon Academy Hallym University, Chuncheon, Korea
- 22Department of Neurology, Seoul National University Hospital, Seoul, Korea
- 23Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- 24Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- 25Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
- KMID: 2565061
- DOI: http://doi.org/10.12779/dnd.2025.24.1.1
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.
