Medical interventions and treatments for dementia
There is no cure for dementia. But, if diagnosed early there are treatments for dementia which can we be used to help slow down the progress of the disease and ease some of the symptoms.
Drugs used in Alzheimer’s treatment
There are two types of medications used to treat Alzheimer’s disease. One type is known as Cholinesterase inhibitors. The generic versions are known as either donepezil, rivastigmine or galantamine.
How do they work? 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 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.
All Cholinesterase inhibitors, as the name suggests, prevent the enzyme from breaking down this important messenger chemical in the brain. In this way, the medicine 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.
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.
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. Antidepressant medicines may be prescribed to alleviate the symptoms.
Unlike the medications discussed above, the various psychological treatments do not affect the underlying Alzheimer disease. Instead, they are used to alleviate symptoms, provide some sense of control and action to people who may feel out of control and helpless upon diagnosis of dementia.
Cognitive stimulation and Reality Orientation therapy
Cognitive stimulation involves helping people with dementia to take taking part in activities and exercises that improve memory, problem-solving skills and language ability.
Evidence suggests that cognitive stimulation can improve thinking and memory skills in people with dementia. It is currently the only psychological treatment directly recommended by the National Institute for Health and Care Excellence (NICE) to help people with mild or moderate dementia.
Reality Orientation therapy reduces feelings of mental disorientation, memory loss and confusion while improving self-esteem.
Behavioural therapy works to understand the source of the difficult behaviour, and then suggest alternative strategies to address the underlying cause without the damage that the problematic behaviour can bring about. For example, a person with dementia may have a history of wandering out of their home or care centre 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, the prescribed regime is individualised; and 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 drugs or try new therapies to support their condition as it progresses.
For more detailed information on all types of treatments please check out the Alzheimer’s society fact sheet.