Dementia Overview (cont.)

Medical Treatment

Treatment of dementia focuses on correcting all reversible factors and slowing irreversible factors. This can improve function significantly, even in people who have irreversible conditions such as Alzheimer disease. Some of the important treatment strategies in dementia are described here.

Correcting drug doses and/or withdrawing misused drugs

Many seniors require ongoing medications for chronic conditions such as heart failure, high blood pressure, high cholesterol, diabetes, prostate enlargement, and many others.

• Reviewing these medications can reveal incorrect doses, drug interactions, side effects, or poor compliance (taking drugs inappropriately or not at all) that could be responsible for part or all of the person's dementia symptoms.
  
  
• Adjustment of doses, elimination of interactions, and development of a drug-taking regimen to ensure that the person takes his or her drugs as prescribed can help reverse symptoms.

Slowing progression of dementia

Dementia due to some conditions, such as Alzheimer disease, can sometimes be slowed in the early-to-intermediate stages with medication. Many different types of medications have been or are being tried in dementia. The medications that have worked the best so far are the cholinesterase inhibitors.

• Cholinesterase is an enzyme that breaks down a chemical in the brain called acetylcholine. Acetylcholine acts as an important messaging system in the brain.
  
  
• Cholinesterase inhibitors, by stopping the breakdown of this neurotransmitter, increase the amount of acetylcholine in the brain of a person with dementia and improve brain function.
  
  
• These drugs not only improve or stabilize mental functions, they may also have positive effects on behavior and activities of daily living.
  
  
• They are not a cure, and in many people the effect is fairly modest. In others, these drugs do not have much of a noticeable effect. Moreover, the effects are temporary, since these drugs do not change the underlying medical condition.
  
  
• Another drug, memantine (Namenda), which works in a different way, is showing promise in certain types of dementia.

Treating depression

Because depression is so common in people with dementia, treatment of depression can at least partially relieve symptoms.

• Depression is usually treated with any of a group of drugs known as antidepressants.
  
  
• The most important of these are the drugs known as selective serotonin re-uptake inhibitors (SSRIs).
  
  
• Stimulant drugs such as methylphenidate (used to treat attention deficit disorders in children) may be used to treat depression in people with dementia.
  
  
• Some of the medications that treat depression also help with anxiety.

Treating specific medical disorders

Treatable disorders revealed by the diagnostic evaluation should receive prompt attention

• Common, treatable conditions that cause or worsen dementia include high blood pressure, high cholesterol, heart disease, diabetes, infections, head injuries, brain tumors, hydrocephalus, anemia, hypoxia, hormone imbalances, and nutritional deficiencies.
  
  
• Treatment varies by disorder.

Treating specific symptoms and complications

Some symptoms and complications of dementia can be relieved by medical treatment, even if no treatment exists for the underlying cause of the dementia.

• Behavioral disorders may improve with individualized therapy aimed at identifying and changing specific problem behaviors.
  
  
• Mood swings and emotional outbursts may be treated with mood-stabilizing drugs.
  
  
• Agitation and psychosis (hallucinations and delusions) may be treated with antipsychotic medication or, in some cases, anticonvulsants.
  
  
• Seizures usually require anticonvulsant medication.
  
  
• Sleeplessness can be treated by changing certain habits and, in some cases, by taking medication.
  
  
• Infections require treatment with antibiotics.
  
  
• Dehydration and malnutrition may be treated with rehydration and supplements or with behavioral therapies.
  
  
• Aspiration, pressure sores, and injuries can be prevented with appropriate care.