Sadly, there is no cure for dementia. But, if diagnosed early there are medications and therapies which can help slow down the progression of the disease and ease some of the symptoms.
Most of the medication available is used to treat Alzheimer’s Disease as the most common form of dementia. They can help temporarily to reduce symptoms.
Medications for the treatment of Alzheimer’s Disease
There are two types of medications: acetylcholinesterase inhibitors (often shortened to ‘cholinesterase inhibitors’) and NMDA receptor antagonists. The two types work in different ways.
Below we provide details of both types of dementia medication, how they are administered, as well as who may benefit from them, and any side effects to look out for.
1. Cholinesterase inhibitors
A healthy brain has adequate levels of a chemical called Acetylcholine. It helps to send messages between certain types of nerve cells which respond to this chemical. In the brain of a person with Alzheimer’s two problems arise: there are lower levels of the chemical itself, and there is also a loss of the nerve cells which respond to and use acetylcholine.
Falling acetylcholine levels and progressive loss of these nerve cells are linked to worsening symptoms. This process of deterioration is influenced by the presence of an enzyme called acetylcholinesterase.
Cholinesterase inhibitors prevent the enzyme from breaking down this important messenger chemical in the brain. In this way, the Alzheimer’s medication helps to maintain the necessary levels of the chemical, which allows increased communications between nerve cells, and a temporary stabilisation of some of the Alzheimer’s disease symptoms.
What are the cholinesterase inhibitor medications called?
Donepezil: originally patented as the brand name Aricept, but more widely available now as the generic Donepezil
Rivastigmine: originally patented as Exelon, and is now also available as other brands as well as generic Rivastigmine
Galantamine; originally patented as Reminyl and is now also available as generic galantamine and the brands Reminyl XL, Acumor XL, Galsya XL and Gatalin XL.
Who are these medications for and what are the benefits?
These medications are prescribed for people with mild to moderate Alzheimer’s disease. Studies show that between 40 – 70% of people taking the drugs benefit from them with symptoms improving temporarily for between 6-12 months.
The impact of taking cholinesterase inhibitor medications can include: reduced anxiety, improvements in memory and concentration; daily activities such as personal care, dressing and shopping.
Trials to determine if these drugs also bring benefits for behavioural changes such as agitation or aggression are inconclusive, with mixed results. Unfortunately the impact of these medications gradually reduces with symptoms then gradually worsening.
How are the medications administered?
By tablet or patch.
Are there side-effects of cholinesterase inhibitors?
There may be side effects, but it is important to note that not everyone experiences the same or has them for the same length of time, if they have them at all.
The most frequent side effects include: loss of appetite, nausea, vomiting and diarrhoea. Other side effects may include muscle cramps, headaches, dizziness, fatigue and insomnia.
The side effects can be less likely for people who start this treatment for dementia with a lower dose, but this must be in consultation with the medical experts. It is also important of course to keep an eye on any side effects and to discuss them with the doctor.
2. NMDA Receptor Antagonists
The second type of medicine is called NMDA receptor antagonists and works on a different process in the brain. In a healthy brain, another helpful chemical – Glutamate – helps to send messages between nerve cells.
In a brain affected by Alzheimer’s disease, Glutamate is present in excessive amounts, and that excess damages nerve cells in the brain. The active ingredient in an NMDA receptor antagonist is Memantine. It can block the effects of excess glutamate, thus protecting the brain cells for longer.
What is the NMDA receptor antagonist treatment called?
Who is the drug for and what are the benefits?
The NICE guidance recommends use of Memantine for people with severe Alzheimer’s disease, and for those with moderate Alzheimer’s who may suffer significant side effects from cholinesterase inhibitor drugs.
For those in the middle and later stages of the disease it can slow down the progression of symptoms such as disorientation, as well as difficulties with daily activities (washing, dressing, shopping).
There is some evidence that memantine may also help with symptoms such as aggression and delusion.
Are there any side effects of Memantine?
The side effects of Memantine are less common and less severe than for cholinesterase inhibitors; they may include dizziness, headaches, tiredness, raised blood pressure and constipation.
Medication for other forms of Dementia
Unfortunately the medications for other forms of Dementia are minimal. Cholinesterase inhibitors may be offered to patients with dementia with Lewy bodies or Parkinson’s disease dementia – if they have particular symptoms such as hallucinations or challenging agitation or aggression. There are no firm scientific conclusions as to the efficacy of Memantine for either of these forms of dementia.
Other Treatments available:
Medicines for depression
Depression is often associated with dementia, though the reasons for this are not clear. Some experts assume that it might be caused by the frustration people with dementia feel, as the disease progresses and worsens. It is an issue for many people and, in a person with dementia, it can make the symptoms worse. Anti-depressant medicines may be prescribed to alleviate the symptoms.
Psychological therapies for dementia
Unlike the medications discussed above, the various psychological dementia treatments available do not affect the underlying Alzheimer’s disease. Instead, they are used to alleviate symptoms, provide some sense of control for the individual and their families and carers.
Cognitive stimulation therapy
Cognitive stimulation therapy (not to be confused with cognitive behavioural therapy) is aimed at those with mild to moderate dementia; it involves taking part in group activities and exercises designed to help improve memory, problem-solving skills and language ability..
It is currently the only psychological dementia treatment directly recommended by the National Institute for Health and Care Excellence (NICE) to help people with mild or moderate dementia.
Group CST treatment involves 7 or more sessions of themed activities, which typically run twice weekly. Longer-term, or ‘Maintenance CST’, is also available and recommended. Sessions aim to actively stimulate and engage people with dementia, whilst providing the social benefits of a group. Activities include discussions, puzzles and crosswords, along with music.
CST is available through local NHS trusts and some charities such as Age UK.
The benefits of cognitive therapy for dementia patients include better grasp of language and speech, improved memory and a more positive outlook on life.
Behavioural therapy for dementia
Behavioural therapy works to understand the source of the behaviour, and then suggest alternative strategies to address the underlying cause.
For example, a person with dementia may have a history of wandering out of their home because they feel restless. Therefore, encouraging such people to find another outlet for their restlessness, such as regular physical activity, might address the problematic behaviour.
Behavioural therapy is not a solution to the many behavioural problems associated with dementia (depression, aggression or delusional thinking), but it is a useful tool in lessening their impact. Behavioural therapy is supervised by a healthcare professional, but can often be given by a trained friend or relative, usually the main family carer.
As in all treatments for any disease, everyone is different and reacts differently; results can vary by day or even parts of days. It is, therefore, important to keep checking in with the medical team if you notice any changes in your parent’s behaviour. It may be possible to change the dementia drugs or try a new dementia therapy to support their condition as it progresses.
To help make sure you know what to look out for, we’ve put together a list of the most common early signs of dementia, which you can take a look at in more detail. You can also download our free guide to dementia for information on diagnosis, legal considerations and support available.