Dementia Treatment

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• QWhat type of doctor treats dementia?

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  A Dr. Stephen T. Chen, MD , Geriatric Medicine, answered on behalf of UCLA Health

  Doctors that can help treat vascular dementia include:

  • geriatric or adult psychiatrist who may visit skilled nursing facilities or assisted living facilities
  • geriatric medicine doctor, an internist who has received special training in geriatric medicine
  • neurologist, a doctor trained in brain illnesses, including dementia
• QCan dementia be cured?

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  A Sigma Nursing answered

  Some forms of dementia can actually be reversed if your brain hasn't suffered too much damage. In order to reverse dementia, you have to know what is causing it. Certain factors like HIV, other infections, or a vitamin B deficiency could be the cause. If that's the case, you may be able to reverse your dementia by treating the cause directly. Similarly, if your symptoms are being caused by a brain tumor, they may disappear if the tumor is removed. Reducing the amount of alcohol you consume can have a positive effect as well. For types of dementia that aren't reversible, there are usually treatment options available to help slow the progression of the disorder. However, there is no cure for Alzheimer's Disease at this time.

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• QHow is dementia treated?

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  A NewYork-Presbyterian Hospital answered

  Some dementias are caused by treatable medical conditions. When doctors treat the underlying condition the patient's mental function may be restored. Most dementias cannot be reversed, though, and in these cases doctors' goal in treatment is to improve symptoms. Symptoms are sometimes alleviated by medications including:

  • Antidepressants for patients whose dementia is accompanied by depressive symptoms.
  • Cholinesterase inhibitors, medications used for Alzheimer's disease, which increase the levels of neurotransmitters in the brain.
  • Parkinson's disease medications, which can help reduce Parkinson's-like symptoms in some patients with Lewy body dementia.
  • Antipsychotic medications, which can alleviate delusions and hallucinations in some dementia patients.

  In the early stage of dementia patients may benefit from a form of rehabilitation called cognitive training. Using memory aids such as mnemonics, computerized recall devices, or note-taking, for example, patients with dementia can sometimes improve their cognitive functioning.

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• QWhat drugs are used to treat dementia?

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  A Dr. David B. Reuben, MD , Geriatric Medicine, answered on behalf of UCLA Health

  Cholinesterase inhibitors are a class of drugs widely used as a first-line treatment for dementia. The brand names include Aricept, Razadyne and Exelon. These drugs may be of some benefit in Alzheimer’s disease, Lewy body dementia, vascular dementia -- particularly if there’s also Alzheimer’s disease -- and Parkinson’s disease dementia. However, cholinesterase inhibitors do not prevent the progression from mild cognitive impairment to dementia, and should not be taken by people with mild cognitive impairment.
  
  Another type of drug, memantine, sold under the brand name Namenda, is also used to treat dementia.
• QIs there any treatment for Binswanger's disease (BD)?

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  A Piedmont Heart Institute answered

  There 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.
• QHow long does it take for a medication for dementia to work?

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  A Dr. David A. Merrill, MD , Psychiatry, answered on behalf of UCLA Health

  If a person with dementia starts treatment with a medication, he or she should expect behavioral improvements within two to four weeks, or a relatively short time-frame. A follow-up can certainly be done within a month. This can be done via a face-to-face appointment with the doctor or by a phone call.

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• QWhat questions should I ask my doctor about medications for dementia?

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  A Dr. Sarah N. Mourra, MD , Neurology, answered on behalf of UCLA Health

  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?

  Getting answers from the doctor during the visit can help you be aware of what a medication can potentially do and the way that it interacts in an older individual with dementia who has multiple medical problems and is taking multiple other medications.
• QHow safe is it for a person with dementia to take multiple medications?

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  A Dr. Sarah N. Mourra, MD , Neurology, answered on behalf of UCLA Health

  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.
• QCan melatonin and light improve the sleep cycle of a person with dementia?

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  A Dr. John H. Growdon, MD , Neurology, answered

  People who have dementia often have a diminished ability to track or react to day and night transitions. Both light from the environment and the hormone melatonin are necessary for normal circadian rhythm (the 24-hour sleep-wake cycle).
  
  Researchers studied 189 residents in 12 assisted-care facilities, most of whom had dementia. Some residents received doses of bright light between 9 a.m. and 6 p.m., some took supplements of melatonin or placebo pills, and some received both treatments. A fourth group received no treatment. Almost all of the participants completed at least a year of the study.
  
  People in the facilities with bright daytime lighting appeared to have less progression in their dementia. They had 53% less of a decline in physical function scores, and 5% less decline in memory test scores, compared with the average decline at dimly lit facilities. Patients exposed to bright light were also 19% less likely to develop depression during the time of the study.
  
  People who took melatonin without bright light frequently complained of depression and were more likely to become socially isolated. This suggests that melatonin alone is not useful. However, when melatonin and bright light exposure were combined, depression rates were not higher than expected, and after several months of use, sleeping patterns seemed to improve. There was longer uninterrupted sleep, less frequent episodes in which residents were up out of bed at night, and somewhat less agitated behavior, according to researchers, who reported their findings in Journal of the American Medical Association (JAMA) in 2008.
  
  For people with dementia and for their caregivers, the use of bright lights is a simple, safe change. It may be helpful to combine light therapy with melatonin for people who have difficulty getting to sleep or staying asleep. These findings could improve the quality of life for people with dementia and ease strain on those who care for them.

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• QWhat are the side effects of antipsychotic drugs in people with dementia?

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  A Dr. Sarah N. Mourra, MD , Neurology, answered on behalf of UCLA Health

  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.