There isn’t a cure for dementia right now, but doctors and scientists all over the world are doing research into new medicines. In the meantime, there are some medicines that can help people think more clearly.
Dementia Treatment
Some forms of dementia are caused by medical conditions that can be treated. If reversing dementia isn't possible, there are methods to slow progression of the brain disorder and improve brain function. Dimentia treatment may include medication as well as cognitive training, focusing on improving brain function and memory. The treatment approach will depend on the dementia symptoms and an individual's overall health. Learn more about treating dementia with expert advice from Sharecare.
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5 AnswersA
See All 5 AnswersIf there is an acute cause of a behavioral symptom in dementia, doctors do not jump in and treat the person with psychotropic medications. Instead, they try to use non-psychopharmacological approaches to treat the cause itself.
Once those causes have all been taken care of, or if none have been identified, doctors will still try to avoid treatment with psychotropic medications by trying to modify the environment that the person is living in. For example, is there a way to either avoid or fix the stressor that’s causing a particular behavior in order to make it better? If somebody is wandering, can something be changed to prevent it? If a task is too complex, can it be made simpler? In advanced dementia, if somebody has trouble eating, can assistance be given? Doctors will try to keep the person’s activities appropriate for the level of dementia that exists.
Later on, things might need to be done for people who can no longer do certain tasks. It is, however, important to keep realistic expectations both for the person and the caregivers in terms of non-medication approaches to treating behavioral symptoms.
Eventually, the doctor may turn to medications for specific target symptoms. If a symptom looks like depression or anxiety, an antidepressant might be prescribed. If the person is suffering from something like hostility, suspiciousness, paranoia or things that are out of touch with reality (which basically define psychosis), the doctor may try antipsychotics.
However, it's important to bear in mind that no medications are actually approved by the U.S. Food and Drug Administration (FDA) for behavioral disturbance and dementia. The help of behavioral experts, combined with that of doctors or specialists, will determine whether or not it's right to use a particular medication.
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1 AnswerA
The side effects of antipsychotic drugs used to treat people with dementia vary depending on the potency of the medication. Medications that are low potency, such as quetiapine (Seroquel), tend to have effects like sedation or oversedation and low blood pressure when going from a sitting to a standing position (orthostatic hypotension). This may manifest as the person feeling dizzy when getting out of bed in the morning or feeling lightheaded when getting up from a chair. This, at its very worst, can lead to falls or passing out, which is very important to be mindful of, especially if started recently.
Risperidone (Risperdal) is an example of a higher potency medication. It tends to have more effects along the lines of potentially creating Parkinson’s-like symptoms, such as affecting the ability to walk normally, with more of a shuffling gait; tremor; involuntary movements of the face or mouth; as well as stiffness and rigidity in the muscles of, usually, the upper extremities but which may occur anywhere else. The higher potency agents can cause sedation and a higher risk for falls as well. -
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Unfortunately, as with Alzheimer's disease, there are no drugs that were developed specifically for behavioral disturbances associated with vascular dementia. However, when the risk-benefit is right, doctors will use psychotropic or psychiatric medications to treat specific symptoms.
If a patient has low energy and apathy, doctors may try an antidepressant that’s energizing and uplifting. If he or she has suspiciousness about what's going on, doctors may try an antipsychotic. Through a decision process, medication with management considerations may be tried. However, there will be a constant reevaluation of the usefulness of the medication and constant monitoring of the drugs’ safety and side effects. -
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One of the considerations in people with dementia is the issue of multiple medications (polypharmacy). Specifically, polypharmacy has been defined as the use of five or more medications that can have potential interactions with each other. Many people with dementia take more than five medications. You should work with the doctor to make sure that all these medications are actually needed. This includes vitamins and herbal remedies as well.
Polypharmacy has been associated with increased frailty, weight loss, weakness, exhaustion when doing very small activities, increased mortality, increased disability and increased falls. How much does polypharmacy increase fall risk? It’s been found that if the person is on five to nine medications, he or she is four times more likely to fall. If the person is on more than 10 medications, the risk of falling increases by six times. Less is more, so it’s important to reassess medications regularly to see if the person needs all these medications or determine if there are ways of simplifying the medication regimen so that polypharmacy can be decreased. -
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In terms of important side effects from acetylcholinesterase inhibitors in people with dementia, the main thing to consider is that all of these medications have adverse effects in terms of loss of appetite, nausea or gastrointestinal (GI) symptoms like diarrhea. When people are started on these medications they may begin losing their appetite. For people who may be more nonverbal, this may manifest as more irritability, refusing meals and mood changes. It’s important to be aware of the timing of these medications and to monitor your loved one or elder’s eating habits and schedule following initiation of these medications.
Oftentimes, rivastigmine (Exelon) is the worst offender when it comes to the GI side effects, which is one reason why the patch form of this drug is helpful. The patch form does not have the risk of GI side effects like the oral form does.
The second major thing to look out for with acetylcholinesterase inhibitors is that they can lower the heart rate. What this means is that for individuals who may already have a low heart rate, the medication may lower their heart rate further, putting them at risk for passing out or falling from decreased blood flow to the brain. Therefore, it’s important to monitor your elder or loved one for dizziness or falling after starting these medications and to monitor his or her heart rate. Because of this risk, doctors will typically not start one of these medications unless the heart rate is above 60 beats per minute. -
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Common medications that treat mood symptoms–typically depression–in people with dementia are antidepressants. The following are the classes of antidepressants:
- selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac) and paroxetine (Paxil)
- serotonin-norepinephrine reuptake inhibitors (SNRIs), which have noradrenergic in addition to serotonergic activity and include duloxetine (Cymbalta) and venlafaxine (Effexor)
- bupropion (Wellbutrin), which is not considered an SSRI or SNRI; it has a more dopamine-related method of action
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1 AnswerA
There are some important questions to ask the doctor if you are caring for a person with dementia. Doctors are open to questions because a lot of times they are possibly not looking at the entire picture or the appointment is rushed. Having the caregiver as an active participant is very important to help the doctor collect all the information in order to make a decision that’s going to be a healthy one for the person. Here are some questions you could ask:
- Is this medication really needed?
- Is this medication the most appropriate for the medical condition being treated?
- Will the medication be a problem for other medical conditions that are occurring at the same time?
- Is the medication being prescribed at the right dose?
- Does the medication interact with other medications?
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Piedmont Heart Institute answeredThere is no specific course of treatment for Binswanger's disease (BD). Treatment is symptomatic. People with depression or anxiety may require antidepressant medications such as the serotonin-specific reuptake inhibitors (SSRI) sertraline or citalopram. Atypical antipsychotic drugs, such as risperidone and olanzapine, can be useful in individuals with agitation and disruptive behavior. Recent drug trials with the drug memantine have shown improved cognition and stabilization of global functioning and behavior. The successful management of hypertension and diabetes can slow the progression of atherosclerosis and subsequently slow the progress of BD. Because there is no cure, the best treatment is preventive, early in the adult years, by controlling risk factors such as hypertension, diabetes, and smoking.
This answer is based on source information from the National Institute of Neurological Disorders and Stroke. -
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Riverside Center for Neurosciences answeredThere is no treatment available to reverse the brain damage caused by a stroke. Treatment focuses on preventing future strokes by controlling or avoiding the diseases and medical conditions that put people at high risk for stroke: high blood pressure, diabetes, high cholesterol, and cardiovascular disease. The best treatment for multi-infarct dementia (MID) is prevention early in life-having a healthy diet, exercising, not smoking, consuming only moderate amounts of alcohol, and maintaining a healthy weight.
This answer is based on source information from the National Institute of Neurological Disorders and Stroke.