How is dementia treated?

Dr. David A. Merrill, MD
Psychiatrist (Therapist)

If 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.

Dr. Zaldy S. Tan, MD
Geriatric Medicine Specialist

There are several medications that are approved by the FDA to treat Alzheimer’s disease and other forms of dementia. The two classes of medications are the cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) and the NMDA-receptor antagonists (e.g., memantine). These treatments may improve symptoms such as forgetfulness, but they cannot cure the disease. The response to these medications are rather modest—equivalent to roughly six months reversal of symptoms. Discuss with your healthcare provider which medications are appropriate.

Dementia cannot always be treated, but there are a few medications that may be able to improve brain function and slow progression of the disorder in some cases. Chlorinesterase inhibitors like donepezil, rivastigmine and galantamine can be used to increase levels of neurotransmitters in the brain, which may help improve neurological function in people with Alzheimer's disease, Lewy body dementia, and vascular dementia. Memantine has shown promise in treating dementia as well, especially in Alzheimer's disease patients. If your dementia is caused by something like high blood pressure or high cholesterol, you may be able to improve it by specifically treating those factors. The same can be said for causes that can be controlled. Medications such as antipsychotic drugs and anticonvulsants might be used to control the behavioral symptoms of dementia as well.

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.

We can give several medications as treatment, depending on the stage of dementia. These medications aren’t going to improve the patient’s memory, but they will definitely slow the memory loss. If the patient also has depression, we can add some depression medications to improve their general well-being. If they have paranoia or delusions, we can treat that so that there is no aggression and so there are no psychotic episodes.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.