How is dementia treated?

Dementia medications

Upon receiving a diagnosis of dementia, which may include Alzheimer’s disease, vascular dementia, Lewy body dementia, or frontotemporal dementia, individuals will typically be prescribed one or more anti-dementia medications. Medications, such as acetylcholinesterase inhibitors or NMDA receptor antagonists can help to reduce the impact of symptoms and potentially slow the effects of dementia ^[1].

Acetylcholinesterase inhibitors (also known as cholinesterase inhibitors)

There are several brain changes that occur in those with dementia. First there is a reduced level of acetylcholine, a chemical that aids in communication between nerve cells. There are also fewer neurons to carry and use acetylcholine. These changes lead to degeneration of the brain and worsen dementia symptoms ^[2].

Cholinesterase inhibitors block acetylcholinesterase, the enzyme responsible for this reduction in acetylcholine production and use. This helps to improve and maintain nerve cell communication and reduce symptoms of dementia ^[2][3].

Commonly prescribed cholinesterase inhibitors include donepezil, rivastigmine, and galantamine. Potential side effects of these medications include nausea, vomiting, diarrhea, weight loss, and reduced heart rate, although these side effects typically improve within the first few weeks ^[1][3].

NMDA receptor antagonists

Damage to nerve cells that occurs with dementia causes an increase in glutamate, a chemical which also helps communication between nerve cells. This excess of glutamate leads to further damage of nerve cells, thus worsening dementia symptoms ^[2].

NMDA receptor antagonists help to prevent the effects of high glutamate levels, protecting nerve cells from damage and mitigating the effects and symptoms of dementia ^[2][3].

A commonly prescribed NMDA receptor antagonist is memantine, which can be used alongside or instead of a cholinesterase inhibitor. Potential side effects of memantine include constipation, headaches, and dizziness, although these typically improve in a short time ^[1][3].

Other medications

Dementia can cause other symptoms, such as depression, anxiety, aggression, and psychosis, which are referred to as behavioral and psychological symptoms of dementia (BPSD). These symptoms can cause distress and harm to the individual and others, so may require intervention, which should first be attempted with non-drug approaches ^[3][4].

If necessary, medications can be prescribed but the effects require close monitoring, as they often cause an increased risk of side effects, such as drowsiness, dizziness, and mobility issues, which can increase the risk of falls; gastrointestinal complaints, such as nausea, vomiting, diarrhea, and constipation; and cognitive effects, such as confusion and increased memory loss ^[1][4].

BPSD medications may include ^[1][4]:

• Antidepressants: to help improve mood, anxiety, and agitation
• Anxiolytics (also known as anti-anxiety medications): to help reduce anxiety, verbal and physical aggression, and agitation
• Antipsychotics: to help reduce symptoms of psychosis, such as hallucinations, delusions, and paranoia, as well as managing aggression and agitation

Antipsychotic medication should only be used if necessary for the safety and wellbeing of the individual and with extreme caution, as they have been found to greatly increase the risk of severe side effects, stroke, and death in older adults with dementia ^[1].

Dementia therapies

Various types of therapy can be utilized in the treatment of dementia, although their effectiveness may vary depending on the type of dementia and severity of symptoms, as well as the individual’s abilities and preferences ^[5].

Cognitive stimulation therapy

Cognitive stimulation therapy (CST) is typically provided to a group, in which people with dementia engage in exercises and activities that are designed to stimulate the brain and improve cognitive function in a fun and enjoyable way ^[3].

CST has been found to improve learning abilities, communication skills, memory, and problem-solving abilities, while encouraging and promoting social skills and relationships ^[3][6].

Talk therapy

Talk therapies, such as psychotherapy and cognitive behavioral therapy, can be effective treatments for those in the early to middle stages of dementia, when individuals are still able to communicate and engage in therapy effectively, which is likely to become more difficult as the medical condition worsens.

Receiving a diagnosis of dementia and coping with the challenges that are faced within the context of this condition can cause emotional distress, such as feelings of depression and anxiety, which can be discussed and treated by a trained therapist ^[5][7].

Therapy can also help to manage negative emotions that may occur as the condition progresses, teach positive coping strategies, and recognize and alter harmful thoughts and behaviors ^[7].

Occupational therapy

Trained professionals, such as an occupational therapist (OT), can help individuals with dementia to maintain their independence. OT’s can help individuals can provide individuals with useful tools and strategies to help the them adapt their lifestyle depending on their impairments and needs ^[3][8].

An OT can also provide a home assessment and make changes to the environment to improve movement and functioning in the home and reduce the risk of falls or injury, such as adding handrails, using label reminders, and altering furniture placements. The aim of this is to ensure that the individual can remain living at home for as long as possible, promoting their independence ^[8].

Alternative therapies

Aromatherapy, massage therapy, music therapy, and animal therapy can be enjoyable and helpful interventions for those with dementia, to provide sensory stimulation. For some, these interventions can help to reduce distress, aggression, and agitation, and improve mood and relationships with caregivers ^[1].

Evidence of the effectiveness of certain alternative therapies and remedies is varied, and may differ depending on the individual’s preferences, cognition, and symptoms, so should be discussed, and reviewed regularly if utilized ^[1][3].

Self-help techniques

Living with dementia can cause challenges with daily living and have a negative impact on mood and wellbeing, so there are various strategies that can be utilized to help manage or improve these issues, such as ^[3][8][9]:

• Socializing: Engaging in social activities can help to maintain mental wellbeing, by being active, speaking with others, and taking part in hobbies and enjoyable occasions, as well as providing opportunities to share experiences with others who also have a diagnosis of dementia.
• Brain stimulation: Activities such as reading, doing puzzles and crosswords, having conversations, and watching television can keep the brain active, helping to reduce boredom and frustration and maintain cognitive abilities.
• Labels and reminders: You may find it useful to label cupboards or items as reminders of where things are or how they work, as well as utilizing calendars and reminders to keep track of appointments, bill payments, and medication dosage times.
• Time orientation: Dementia can cause individuals to lose track of the time and date, so it can be useful to use a dementia-friendly clock, use a calendar, watch, or read the news, and regularly speak with others to help maintain or improve time orientation.
• Regular routines: Forming and keeping regular routines can be useful for those with dementia to help prevent issues related to short-term memory loss or confusion.
• Reminiscing: Having photos in your home, listening to music, or watching shows that you used to enjoy, and speaking with others about the past can help to improve mood by thinking about enjoyable and happy memories, as well as distracting from any distress caused by your condition.
• Maintaining wellbeing: Looking after your general health and wellbeing can help to reduce the impact of dementia symptoms, such as eating a healthy diet, engaging in regular exercise, getting plenty of sleep, and attending regular checkups for eyesight, hearing, and dental health.