Aging & Health A to Z
Care & Treatment
There is no cure for Alzheimer’s disease or vascular dementia. But there are medications, treatments, and strategies that can slow declines, help people with dementia make the most of the abilities they have and function as well as possible to have the highest possible quality of life.
When caring for someone with dementia, physicians and other healthcare professionals will:
- Identify, treat, and monitor underlying health problems, such as heart disease and diabetes, that boost risks of dementia and can worsen symptoms
- Check for and treat other things that contribute to changes in mental abilities and mood, such as depression, pain, hearing loss or vision loss
- Watch for new medical problems
- Check for drug side-effects
- Teach caregivers how to best manage symptoms, behavioral problems, and find caregiving, financial, and legal support
The below are issues that healthcare professionals should also consider:
- Healthcare providers should take the patient off any anticholinergic drugs he or she may be taking. These drugs can contribute to mental decline. Commonly prescribed anticholinergic medicines include the blood pressure drug nifedipine (brand names Adalat and Procardia), the stomach antacid ranitidine (Zantac), and tolterodine (Detrol), which is prescribed for loss of bladder control.
- Healthcare professionals should not prescribe cholinesterase inhibitors for dementia without periodic assessment of apparent cognitive benefits and negative gastrointestinal effects. These drugs may temporarily slow declines in cognition, mood, behavior and daily functioning in people with early dementia. Commonly prescribed cholinesterase inhibitors are donepezil (brand name Aricept), galantamine (Razadyne) and rivastigmine (Excelon). You should talk to your healthcare provider about your treatment goals before trying any drugs in this category.
- To treat new symptoms such as agitation or aggression, healthcare providers should:
- Recommend certain care or management strategies
- Discontinue medications
- Consider prescribing new medications only as a last resort
Use of non-drug treatments for behavioral symptoms
Drugs called “atypical antipsychotics” are often prescribed for older adults with behavioral symptoms of dementia—but numerous studies now show that these medications are rarely effective for these patients. What’s worse, these drugs can cause serious side effects, including stroke and death.
Due to recent well-designed studies, the American Geriatrics Society (AGS) and the British National Institute for Health and Clinical Excellence and Social Care Institute of Excellence (NICE-SCIE) have concluded that non-drug treatments should be tried first, and symptoms should be managed with non-drug strategies in most circumstances. Overall, these non-drug treatments are both safer and more effective than medications. Antipsychotic drugs should be tried only in cases in which non-drug approaches haven’t worked and “there is severe distress or an immediate risk of harm to the person with dementia or others.”
Updated: February 2014
Posted: March 2012