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There are dozens of methods of treating dementia, but these five general treatments are the most useful for the greatest number of patients.

There are no cures for most forms of dementia, but there are treatments that can help. Let's start by looking at a pharmaceutical approach.

Medications

There is no drug that reverses dementia, but some medications reduce symptoms or slow the progress of the disease. Nearly all pharmaceutical treatments for dementia, however, carry a risk of serious side effects.

Antidepressants are frequently prescribed for irritability and depressed moods. In almost all cases, dementia patients are offered selective serotonin reuptake inhibitors (SSRIs), which sometimes make it possible to discontinue antipsychotic medications that have severe side effects. The most commonly prescribed SSRI in dementia is citalopram (Celexa).

Antipsychotic medications are used "off label" to curb aggression, hostility, delusions, and hallucinations. In the United States, these medications come with a "black box" warning that they cause increased likelihood of death when used in dementia. These drugs commonly cause extrapyramidal symptoms such as:

  • Dystonia (muscle stiffness, rigidity, and spasms, sometimes with unusual eye movements). 
  • Akathisia (inability to sit down; many patients stand up and sit down repeatedly).
  • Parkinsonism (shuffling gait, expressionless face, drooling, rigidity, tremor).
  • Tardive dyskinesia (involuntary movements of muscles of the face and around the mouth, puckering, sticking out the tongue, chewing, grimacing, which may become permanent).

There drugs to counteract most of these side effects, except for tardive dyskinesia, which can only be treated by stopping the antipsychotic drug.

Anti-anxiety medications (anxiolytics) are used to decrease restlessness and to relieve anxiety. The problem with these drugs, which include lorazepam (Ativan) or oxazepam (Serax), is that they increase the risk of falls as much as 10-fold.

Cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) increase levels of a neurotransmitter called acetylcholine, and keep it from breaking down. These drugs are the main treatments for Alzheimer's disease, although they are comparatively seldom prescribed for other forms of dementia. What families often fail to understand is that "no change" is considered an "improvement" for these medications. They can cause low blood pressure, diarrhea, nausea, vomiting, muscle cramps, and falls.

Memantine (Namenda) may relieve severe confusion. It can cause aches and pains, constipation, dizziness, and headaches.

Many care facilities turn to medications for easier management of difficult cases, but there are many other modes of treatment that don't carry the same risk of side effects. 

Cognitive stimulation therapy

Cognitive stimulation therapy is a group activity for people who have mild to moderate dementia. The group may gather around a shared experience (for instance, military veterans) or a shared interest (for example, cooking and eating food). These sessions typically last 45 minutes to an hour, and can become a highlight of the patient's day. Both the patient's quality of life and cognitive function often demonstrably improve. Care facilities can access computer programs that provide a framework for discussion tailored to the needs of people who have dementia. 

Creative expression therapy, also known as games

"Creative expression therapy" is a catch-all term for an activity many of us would call "playing games". People who have dementia often retain the ability to play board games, word games, and cards, especially if they have routinely played these games in the past. Games give people who have dementia an opportunity to use creativity, imagination, and thinking processes that otherwise may remain unused. Some of these thinking processes may help them cope with other activities of daily living, and to communicate more easily with caregivers and family. It may be necessary to bend the rules to prevent upset; the objective isn't to beat someone who has dementia at their favorite game. 

Reality orientation

Reality orientation consists of going over basic details of life such as name, date, and location, but there are limitations to this approach:=—  many patients find it patronizing. My father, for example, once was asked by his nurse in a tone more often used with small children, "And can you tell me your first name today?" He answered, "To you, it's Mister."

Reminiscence therapy

Reminiscence therapy consists of sharing memories of loved ones, stories about growing up, and mementos of former homes and connections. Sharing memories often reduces depression and improves thinking skills of patients, but it also maintains the ties with family and friends. One way to approach this kind of therapy is to load photos and video clips onto a pad computer. Some people with dementia are still able to use a pad computer. Others are not. But the pad can become a focus of continuing connection between patients and their loved ones to help them maintain their relationships a little longer.

Dozens of other therapies may help just a little to manage the symptoms of dementia, including aromatherapy, music therapy, and drama therapy, to name only a few. The most important therapy for both patient and family, however, is staying connected just as long a possible. Human connections keep dementia bearable for both patients and those who love them.

  • Astell AJ, Smith SK, Potter S, Preston-Jones E. Computer Interactive Reminiscence and Conversation Aid groups-Delivering cognitive stimulation with technology. Alzheimers Dement (N Y). 2018 Sep 6.4:481-487. doi: 10.1016/j.trci.2018.08.003. eCollection 2018. PMID: 30258977.
  • Berry SD, Placide SG, Mostofsky E, Zhang Y, Lipsitz LA, Mittleman MA, Kiel DP. Antipsychotic and Benzodiazepine Drug Changes Affect Acute Falls Risk Differently in the Nursing Home. J Gerontol A Biol Sci Med Sci. 2016 Feb.71(2):273-8. doi: 10.1093/gerona/glv091. Epub 2015 Aug 5. PMID: 26248560.
  • Mathys M, Fang S, John J, Carter J. Antipsychotic discontinuation after the initiation of selective serotonin reuptake inhibitors therapy for the treatment of behavioral and psychological symptoms associated with dementia. Ment Health Clin. 2018 Apr 26.8(3):122-126. doi: 10.9740/mhc.2018.05.122. eCollection 2018 May. PMID: 29955557.
  • Photo courtesy of SteadyHealth

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