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Dementia treatment
Psychotherapy
Environmental modifications
Medication
Other therapies
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Treatment of dementia begins with treatment of the underlying disease, where possible. The underlying causes of nutritional, hormonal, tumour-caused or drug-related dementias may be reversible to some extent. For many other diseases, such as Alzheimer’s Disease, there is no cure. However, improvement of cognitive and behavioural symptoms can be achieved through a combination of appropriate medications and psychotherapy.
The goal of treatment is to slowdown the progression of dementia-related impairments and to control behavioural symptoms, which may be treated with a combination of psychotherapy, environmental modifications, and medication.
Psychotherapy
Psychotherapy, in particular behavioural approaches, can be used to reduce the frequency or severity of problematic behaviours, such as aggression or socially inappropriate conduct. Identifying what might be triggering a problematic behaviour and then devising an intervention that either changes the person’s environment or the caregiver’s reaction to the behaviour can be effective. Other strategies may include breaking down complex tasks, such as dressing, into simpler steps, or reducing the amount of activity in the environment to avoid confusion and agitation.
Environmental modifications
Modifying the environment can increase safety and comfort while decreasing agitation. Home modifications for safety include removal or lock-up of hazards such as sharp knives, dangerous chemicals, and tools. Child-proof latches may be used to limit access. Bed rails and bathroom safety rails can be important safety measures as well. Another example is lowering the hot water temperature, which reduces the risk of burning or disabling the stove or using stove childproof knobs may be necessary to prevent cooking accidents.
Medication
Medication can be prescribed to reduce dementia symptoms. There are a number of drugs available today for improving brain function. Typically, anti-dementia or other psychotropic drugs are prescribed.
The more recent anti-dementia agents belong to the so-called acetylcholinesterase inhibitors. Acetylcholine is one of the chemical substances that allow brain cells to communicate with one another, the so-called neurotransmitters. Research suggests that acetylcholine is reduced in the brain of Alzheimer’s dementia patients. This kind of drugs prevents acetylcholine to be eliminated too quickly, prolonging its ability to conduct chemical messages between brain cells. It could be shown in clinical trials that, with this kind of drugs, the deterioration of the disease could be delayed by at least 12 months. Apart from preserving and partially improving mental capacities, and coping with daily activities, a delayed onset of behavioural disturbances and a reduction in caring time could also be demonstrated.
Psychotropic drugs can be used as a supportive therapy in the treatment of behavioural problems in dementia. For instance, antipsychotic medications (typically used to treat disorders like schizophrenia) can be effective in reducing delusions and hallucinations. Anti-anxiety medications (typically used to treat anxiety disorders) can also be prescribed to help treating agitation and restlessness. Likewise, antidepressant medication can be prescribed to alleviate depressive symptoms. Treating depression symptoms is important as depression makes it harder for a person with dementia to remember things and enjoy life. It also adds to the difficulty of caring for someone with dementia. Significant improvements can be made by treating depression, as the patient’s mood and their ability to participate in activities may be improved.
In general, medications should be administered very cautiously to patients with dementia, in the lowest possible effective doses, to minimise side effects. Supervision of taking medications is generally required.
One must bear in mind, however, that these medications do not cure the disease or reverse someone’s symptoms. There is no evidence that life is prolonged by taking medications. Rather, these medications can help some people function at a higher level for a longer period of time.
Other therapies
Other therapies may also help persons with dementia with activities of daily living. Physical therapy may improve mobility by teaching patients to use canes or walkers properly and showing them how to get in and out of chairs or beds. Aroma, music, reminiscence, or occupational therapy, as well as art activities, may be beneficial and have a calming or rewarding effect for the person with dementia.
Finally, a growing number of herbal remedies, vitamins and other dietary supplements are promoted as treatments for Alzheimer’s dementia and related diseases. They can be appealing to some people as they come from natural ingredients. Although many of these remedies may be valid candidates for treatment, using these drugs as an alternative or in addition to physician-prescribed therapy raise legitimate concerns. For instance, effectiveness and safety of these products are not established since not much scientific testing has been done. Further, they may not be manufactured consistently by all vendors or always contain the ingredients listed on the label. Moreover, herbal and nutritional supplements can interact with prescribed medications in harmful ways. Therefore, no supplement should be taken without first consulting a physician or informing the doctor treating the dementia patient.
Apart from treating the specific symptoms of dementia, it is important to observe the general state of health because a good general condition improves the feeling of well-being and might prevent or delay the onset of the disease.
