May 16th 2023
Dementia causes impairments in cognitive function. Impairments can include memory loss, reduced communication and problem-solving skills, and impacted mobility and/or mood.
Treatment for dementia will vary depending on the type and severity of the condition and the individual needs. Typically treatment includes medication and specialized therapy.
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 .
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 :
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