Dementia

Care & Treatment

There is no cure for Alzheimer’s disease or vascular dementia. But there are medications, treatments, and strategies that help.  They can slow declines and 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 that increase risks of dementia and can worsen symptoms (such as heart disease and diabetes).
  • Check for and treat other things that can contribute to changes in mental abilities and mood, such as depression, pain, hearing loss, or vision loss.
  • Watch for new medical problems.
  • Check for medication side effects.
  • Teach caregivers how to best manage symptoms, behavioral problems, and find caregiving, financial, and legal support.

Issues that healthcare professionals should also consider:

  • Healthcare providers should take the patient off any anticholinergic drugs that they may be taking. These drugs can contribute to mental decline.
  • Healthcare providers sometimes prescribe medications called cholinesterase inhibitors to treat dementia symptoms.  If these medications are prescribed, the provider should periodically check to see if the patient is experiencing any apparent cognitive benefits. They should also check to see if there are negative gastrointestinal effects. These medications 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 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

Memantine

Memantine is approved by the FDA for treatment of moderate to severe Alzheimer disease. It does not seem to be effective in earlier stages of the disease.  There is also no information on its effectiveness for other dementias. The most common side effects are constipation, dizziness, headache, and agitation.

Other Agents

A variety of other agents have been studied for their usefulness in treating dementia, including antioxidants, Ginkgo biloba extract, and vitamins.  However, their effectiveness and safety have not been established.

Psychoactive medications such as antipsychotic drugs, antidepressants, and mood stabilizers may help control specific behaviors.  However, their effectiveness is limited and they are associated with an increased risk of death. Additionally, antidepressants have no effect on psychotic symptoms of dementia.

Treatments for Behavioral Symptoms

Drugs called “atypical antipsychotics” are often prescribed for older adults with behavioral symptoms of dementia.  However, 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.

The American Geriatrics Society (AGS) and the British National Institute for Health and Clinical Excellence and Social Care Institute of Excellence (NICE-SCIE) conducted some recent well-designed studies. They 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.” 

Non-drug treatments should be tailored to the older adults’ symptoms and needs. A healthcare provider can screen the older adult for behavioral symptoms and contributors to these symptoms, and work with the older adult and the caregiver to come up with strategies to address them. 

Recognizing Pain

Persons with dementia may be unable to report pain or ask for pain relievers. Caregivers should consider whether pain is the source of new, unexplained symptoms. Common signs of pain include:

  • Facial expressions: slight frown, sad or frightened face, grimacing, wrinkled forehead, closed or tightened eyes, any distorted expression, rapid blinking
  • Verbalizations, vocalizations: sighing, moaning, groaning, grunting, chanting, calling out, noisy breathing, asking for help, verbal abusiveness
  • Body movements: rigid or tense body posture, guarding, fidgeting, increased pacing or rocking, restricted movement, gait or mobility changes
  • Changes in interpersonal interaction: aggressive, combative, resistant to care, decreased social interaction, socially inappropriate, disruptive, withdrawn
  • Changes in activity patterns or routines: refusing food, appetite change, change in sleep or rest pattern, sudden change of common routines, increased wandering
  • Mental status changes: crying or tears, increased confusion, irritability or distress, delirium

 

Last Updated September 2017