How is Dementia Treated?

By. Dr. Golnosh Sharafsaleh

Treatment Options for Dementia: A Guide for Patients and Families

In this post, I will discuss treatment options for a person diagnosed with Dementia. By now, I hope you have read previous posts on GeriAcademy, including when memory changes are abnormal, different types of Dementia, and what a geriatric memory clinic evaluation entails.

A person diagnosed with Dementia is often presented with treatment options that range from non-medication approaches to various medication therapies. One size does not fit all! Each patient receives a personalized treatment plan tailored to their needs and unique health profile.

Non-Medication Treatment Options

Patients in the early stages of Dementia can benefit greatly from Cognitive Rehabilitation, typically conducted by a trained speech therapist. This therapy involves techniques to help patients strengthen memory connections and develop compensation strategies for daily life. Additional non-medication treatments include:

• Supportive Group Therapy: Provides emotional support and shared experiences.

• Education on Dementia: Helps patients and families understand the diagnosis and prepare for disease progression.

• Environmental Modifications: Enhances independent living through supportive tools such as clocks, calendars, to-do lists, visual cues, and clear communication techniques.

These modifications and therapies optimize function and improve quality of life, often enabling people to live at home longer and maintain independence.

FDA-Approved Medications for Dementia

There are now three types of FDA-approved medications that may be considered for Dementia treatment. The choice of medication depends on the type of Dementia, co-existing medical conditions, and individual tolerance. Here’s a breakdown of the available options:

1. Cholinesterase Inhibitors: Approved for mild to moderate Dementia, these medications prevent the breakdown of acetylcholine, a chemical involved in memory and thinking. They may also help with behavioral symptoms. Examples include:

   • Aricept (donepezil)

   • Exelon (rivastigmine)

   • Razadyne (galantamine)

   Common side effects: nausea, vomiting, diarrhea, muscle pain, and weight loss.

2. N-Methyl-D-Aspartate (NMDA) Antagonist: Namenda (memantine) is used for moderate to severe Dementia and may be combined with a cholinesterase inhibitor. It can support memory, functioning, and behavior management.

   Common side effects: headache, confusion, diarrhea, and constipation.

3. Anti-Amyloid Monoclonal Antibodies: Recent advancements have led to the approval of new treatments specifically for early Alzheimer’s disease, targeting amyloid plaques in the brain. These therapies can slow the progression of cognitive decline:

   • Leqembi (lecanemab): Approved for early-stage Alzheimer’s to slow amyloid plaque buildup.

   • Kisunla (donanemab): Another promising treatment for slowing disease progression in eligible patients.

   These treatments require close monitoring due to potential side effects, including amyloid-related imaging abnormalities (ARIA) and other risks. Regular MRI scans are part of the treatment protocol to ensure patient safety.

Medications for Managing Dementia-Related Symptoms

Dementia often presents symptoms that may require additional medication, such as mood changes, anxiety, agitation, or sleep disturbances. The use of these medications is considered off-label, meaning they are not FDA-approved for treating dementia.

• Antipsychotics: Used for hallucinations, aggression, or severe sleep disturbances.

• Antidepressants: Help manage depression, anxiety, and agitation.

• Mood Stabilizers: May help with agitation or aggression.

• Benzodiazepines: Used cautiously for sleep and anxiety issues.

The potential benefits of these medications must outweigh their risks, as side effects can be significant.

Before prescribing new medications, I carefully review each patient’s current medication list to rule out any existing medications that might exacerbate Dementia symptoms.

Some Medications that can worsen Dementia symptoms include:

• Antihistamines: Diphenhydramine (Benadryl), Hydroxyzine (Atarax, Vistaril)

• Anti-nausea and anti-vertigo drugs: Meclizine (Antivert)

• Bladder medications: Oxybutynin (Ditropan), Tolterodine (Detrol)

• Benzodiazepines: Alprazolam (Xanax), Lorazepam (Ativan)

Geriatricians are skilled at identifying medications that could be worsening Dementia symptoms and work to reduce or eliminate them when possible.

A Note on Melatonin for Sleep

Melatonin is often a safe, natural supplement to address sleep issues in Dementia. I frequently recommend 1-3 mg taken in the early evening to help regulate sleep patterns. It’s important to consult a healthcare provider before starting melatonin, especially for those with liver disease or other health concerns.

Conclusion

I hope this post clarifies the current treatment landscape for Dementia. Treatment decisions are highly personalized, so please consult with a healthcare provider to determine the best approach. To explore more about memory health, visit other posts on GeriAcademy.

I hope you enjoyed this post on standard treatments for Dementia. Please read other posts by GeriAcademy.