Dopamine precursors/agonists (clonidine, guanefacine, amantadine, bromocriptine) Selegiline
Hydergine, nicergoline Nootropics (e.g., piracetam, oxiracetam)
Neurotrophic factors (e.g., nerve growth factor) Estrogens
MECHANISM OF ACTION
May counteract atrophy of cholinergic neurones
May enhance cognitive function and exert neurotrophic and neuroprotective effects
No adequate evidence of efficacy; see below for combination with vitamin E No adequate evidence of efficacy Non-specific effect on memory but no adequate evidence of efficacy in dementia Tested in small number of patients with limited success; no clinical trials Epidemiological evidence suggests possible benefit but intervention studies show no efficacy
Neuroprotection and cognitive enhancement
Enhance dopamine function
Vitamin E (with selegiline), Ginkgo biloba
Calcium channel blockers
May reduce inflammation associated with neurodegeneration
Block increases intracellular calcium that may mediate cell death
Epidemiological evidence suggests possible benefit but intervention studies show no efficacy Vitamin E plus selegiline maintains activities of daily living and prolongs survival in the community but without measurable improvement in cognitive test performance;Ginkgo biloba used in Europe for dementia syndromes but evidence for its cognitive enhancing properties is weak and inconsistent May delay progression of memory impairment and onset of dementia but there is a lack of controlled data on efficacy
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