Dementia
Treatment Overview
Some cases of dementia are caused by medical conditions that can be treated, fully or partly restoring mental function. When dementia cannot be reversed, the goal of treatment is to make life as easy as possible for the person and the caregivers.
Initial treatment
If the cause of dementia can be reversed, the doctor will prescribe treatment. For example, the person might:
- Take vitamins for a deficiency of vitamin B12.
- Take thyroid hormones for hypothyroidism.
- Have surgery to remove a brain tumor or to reduce pressure on the brain.
- Stop or change medicines that are causing memory loss or confusion.
- Take medicines to treat an infection, such as encephalitis, that is causing changes in mental state.
- Take medicine to treat depression.
- Get treatment for reversible conditions caused by AIDS.
After treatment for reversible conditions, the person will continue to see his or her doctor to make sure the symptoms do not return.
For people with vascular dementia, doctors may prescribe medicines to lower high blood pressure and medicines for high cholesterol (statins). These drugs cannot reverse existing dementia, but they may prevent future strokes and heart disease that can lead to further brain damage.
If the cause of dementia cannot be treated, the doctor will work with the person and caregivers to develop a plan to make life easier and more comfortable. Care plans may include tips to help the person be independent and manage daily life as long as possible. Education of the family and other caregivers is critical to successfully caring for a person with dementia. If you are or will be a caregiver, start learning what you can expect and what you can do to manage problems as they arise. For more information, see the Home Treatment section of this topic.
While medicines cannot cure dementia, they may help improve mental function, mood, or behavior. Medicines that your doctor may prescribe include:
- Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), or rivastigmine (Exelon), to improve or maintain mental function. These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias. Recent studies indicate that they hold promise for the treatment of people with vascular dementia. Both donepezil and galantamine have been shown to improve mental function with few side effects.10, 11 Rivastigmine may help people with dementia with Lewy bodies and Parkinson's disease, but side effects such as nausea, vomiting, and weight loss are common.12 At present, medicines can slow but not stop the progress of dementia.
- Memantine (Namenda). This type of medicine can slow the late stages of Alzheimer's disease. It may also benefit those with mild to moderate vascular dementia.13, 12 More studies are under way.
- Antidepressants to treat depression. They must be used carefully because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are SSRIs, such as fluoxetine (Prozac, for example) and citalopram (Celexa).14
- Medicines to ease anxiety, agitation, aggression, and hallucinations. Some of these medicines, called antipsychotic drugs, are not approved by the FDA for the treatment of dementia. Studies of people with psychosis due to dementia who were treated with these medicines, including Zyprexa and Risperdal, found an increased risk of death.15, 16 Discuss this risk with your doctor before using these medicines.
People who are recently diagnosed and their families should begin to make plans for the future. If possible, make decisions while the person is able to participate in the decision making. These are difficult but important conversations. Questions include:
- What kind of care does the person need right now?
- Who will take care of the person in the future?
- What can the family expect as the disease progresses?
- What kind of planning needs to be done?
As soon as possible after dementia is diagnosed, family members should discuss what financial and legal planning will be needed. Along with a will, the person should write a living will and assign a durable power of attorney for health care. These documents will ensure that the person's wishes for medical care, especially life-sustaining treatment, are recorded. For more information, see Writing an Advance Directive.
Ongoing treatment
The goal of ongoing treatment for dementia is to keep the person safely at home for as long as possible and to provide support and guidance to the caregivers.
Health professionals will work with the person and his or her family or other caregivers to improve mental function as much as possible. Adjustments to the home can make the person's life easier and safer. You can install handrails in showers and remove rugs to improve safety. Calendars and lists can aid memory; you can place sticky notes or signs with pictures on them around the house to help the person remember where objects are stored and to guide the person to the bathroom or kitchen. For more information, see the Home Treatment section of this topic.
The person may also take medicines such as:
- Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), or rivastigmine (Exelon). These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias to improve or maintain mental function. Recent studies indicate that this class of drugs holds promise for the treatment of people with vascular dementia. Both donepezil and galantamine have been shown to improve mental function with few side effects.10, 11 Rivastigmine may help people with dementia with Lewy bodies, but side effects such as nausea, vomiting, and weight loss are common.12 At present, cholinesterase inhibitors can slow but not stop the progress of dementia. It is not clear how long these medicines will work. They may only stop the progress of dementia for a short time.
- Memantine (Namenda). This new type of medicine can slow the late stages of Alzheimer's disease. It may also benefit those with mild to moderate vascular dementia.13, 12 More studies are under way.
- Antidepressants to treat depression. They must be used carefully because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are SSRIs, such as fluoxetine (Prozac, for example) and citalopram (Celexa).14
- Medicines to ease anxiety, agitation, aggression, and hallucinations, which can become worse as dementia progresses. Some of these medicines, called antipsychotic drugs, are not approved by the FDA for the treatment of dementia. Studies of people with psychosis due to dementia who were treated with these medicines, including Zyprexa and Risperdal, found an increased risk of death.15, 16 Discuss this risk with your doctor before using these medicines.
Routine follow-up visits to a health professional (every 3 to 6 months) are necessary to monitor medications and the person's level of functioning.
If the person's condition is getting worse, decisions need to be made while he or she is able to participate in the decision making. Issues include preparing documents such as a living will and a durable power of attorney. These documents ensure that the person's wishes for medical care, especially life-sustaining treatment, are in writing. For more information, see Writing an Advance Directive.
Taking care of a person with dementia is stressful. If you are a caregiver, seek support from family members or friends. Take care of your own health by getting breaks from caregiving. Counseling, a support group, and adult day care or respite care can help you through stressful times and bouts of burnout.
Treatment if the condition gets worse
As dementia progresses, memory, judgment, and the ability to make and carry out plans (executive function) decline. Depending on the type of dementia, the person's behavior may become out of control; the person may become angry, agitated, or combative. The person may wander and become lost. These problems can make it difficult for family members or others to continue providing care at home. The family may have to consider whether to place the person in a care facility that has a dementia unit.
For more information on making the decision about nursing care, see:
Even with the best care, people with dementia tend to have a shorter life span than the average person their age. The progression varies depending on the disease causing dementia and whether the person has other illnesses such as diabetes or heart disease. For more information on decisions you may face as your loved one's condition progresses, see the topic Care at the End of Life.
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| Author: | Jeannette Curtis | Last Updated: June 27, 2007 |
| Medical Review: | Martin Gabica, MD - Family Medicine Peter J. Whitehouse, MD - Neurology | |
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