What's the treatment for dementia?
The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be needed for a short time. The underlying causes should be identified and treated, including treatment for reversible organic lesions such as tumors.
Treatment of dementia begins with treatment of the underlying disease, where possible. The underlying causes of nutritional, hormonal, tumor-caused and drug-related dementias may be reversible to some extent. Treatment for stroke-related dementia begins by minimizing the risk of further strokes, through smoking cessation, aspirin therapy, and treatment of hypertension, for instance. There are no therapies which can reverse the progression of Alzheimer's disease. Aspirin, estrogen, vitamin E, and selegiline are currently being evaluated for their ability to slow the rate of progression.
Care for a person with dementia can be difficult and complex. The patient must learn to cope with functional and cognitive limitations, while family members or other caregivers assume increasing responsibility for the person's physical needs. In progressive dementias such as Alzheimer's disease, the person may ultimately become completely dependent. Education of the patient and family early on in the disease progression can help them anticipate and plan for inevitable changes.
Symptoms of dementia may be treated with a combination of psychotherapy, environmental modifications, and medication. Drug therapy can be complicated by forgetfulness, especially if the prescribed drug must be taken several times daily. Behavioral approaches may be used to reduce the frequency or severity of problem behaviors, such as aggression or socially inappropriate conduct. Problem behavior may be a reaction to frustration or overstimulation; understanding and modifying the situations which trigger it can be effective. Strategies may include breaking down complex tasks, such as dressing or feeding, into simpler steps, or reducing the amount of activity in the environment to avoid confusion and agitation. Pleasurable activities, such as crafts, games, and music, can provide therapeutic stimulation and improve mood.
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 or Dutch doors may be used to limit access as well. Lowering the hot water temperature to 120°F (48.9°C) or less reduces the risk of scalding. Bed rails and bathroom safety rails can be important safety measures, as well. Confusion may be reduced with simpler decorative schemes and presence of familiar objects. Covering or disguising doors (with a mural, for example) may reduce the tendency to wander. Positioning the bed in view of the bathroom can decrease incontinence.
Two drugs, tacrine (Cognex) and donepezil (Aricept), are commonly prescribed for Alzheimer's disease. These drugs inhibit the breakdown of acetylcholine in the brain, prolonging its ability to conduct chemical messages between brain cells. They provide temporary improvement in cognitive functions for about 40% of patients with mild-to-moderate AD. Hydergine is sometimes prescribed as well, though it is of questionable benefit for most patients.
Psychotic symptoms, including paranoia, delusions, and hallucinations, may be treated with antipsychotic drugs, such as haloperidol, chlorpromazine, risperidone, and clozapine. Side effects of these drugs can be significant. Antianxiety drugs such as Valium may improve behavioral symptoms, especially agitation and anxiety, although BuSpar has fewer side effects. The anticonvulsant carbamazepine is also sometimes prescribed for agitation. Depression is treated with antidepressants, usually beginning with selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Paxil, followed by monoamine oxidase inhibitors or tricyclic antidepressants. Electroconvulsive therapy may be appropriate for some patients with severe depression who are unresponsive to drug therapy. In general, medications should be administered very cautiously to demented patients, in the lowest possible effective doses, to minimize side effects. Supervision of taking medications is generally required.
Several drugs are currently being tested for their ability to slow the progress of Alzheimer's disease. These include acetyl-l-carnitine, which acts on the cellular energy structures known as mitochondria; propentofylline, which may aid circulation; milameline, which acts similarly to tacrine and donezepil; and ginkgo extract.
Ginkgo extract, derived from the leaves of the Ginkgo biloba tree, interferes with a circulatory protein called platelet activating factor. It also increases circulation and oxygenation to the brain. Ginkgo extract has been used for many years in China and is widely prescribed in Europe for treatment of circulatory problems. A 1997 study of patients with dementia seemed to show that gingko extract could improve their symptoms, though the study was criticized for certain flaws in its method.
More information on dementia (Alzheimer's disease, vascular dementia, lewy body dementia, Pick's disease)
What is dementia? - Dementia is a deterioration of intellectual function and other cognitive skills. Dementia may involve progressive deterioration of thinking, memory, behavior, personality and motor function.
What types of dementia are there? - Types of dementia include Alzheimer's dementia, vascular dementias, Parkinson disease, Lewy body dementia, alcohol-related dementia, and Pick disease.
What're the risk factors for dementia? - The main risk factor for dementia is age. People who have sustained serious head injuries through boxing are prone to dementia pugilistica.
What causes dementia? - Dementia is caused by degeneration in the cerebral cortex including death of brain cells, conditions that impair the vascular or neurologic structures of the brain.
What're the symptoms of dementia? - The early symptom of dementia is diminished short-term memory. Patients with severe dementia cannot perform activities of daily living.
How is dementia diagnosed? - Diagnosis of dementia begins with a thorough physical exam and complete medical history, and followed by information-concentration-orientation test of Blessed et al. and the mini-mental state exam of Folstein et al.
What's the treatment for dementia? - The goal of treatment is to control the symptoms of dementia. Treatment of dementia begins with treatment of the underlying disease.
What's the long term dementia care? - Long-term dementia care may be needed for some patients with dementia. Possible options include in-home care, boarding homes, adult day care, and convalescent homes.
What's alcohol-related dementia? - Alcohol related dementia is a form of dementia related to the excessive drinking of alcohol. Alcohol abuse can lead to several forms of dementia.
What's frontal lobe dementia? - Frontal lobe dementia is a set of degenerative diseases producing many of the same symptoms as vascular dementia. The frontal lobe governs people's mood and behaviour.
What's senile dementia? - Senile dementia is the mental deterioration (loss of intellectual ability) that is associated with old age. Senile dementia is often used when referring to Alzheimer's disease.
What's early onset dementia? - Early onset dementia is a term that covers a range of diseases affecting memory and thinking in people under the age of 65.
What's AIDS related dementia? - HIV associated dementia (HAD) is comprised of a spectrum of conditions from the mild HIV-1 motor cognitive-motor disorder to severe and debilitating AIDS dementia.
What's Alzheimer's disease? - Alzheimer's disease is a form of degenerative brain disease resulting in progressive mental deterioration with disorientation, memory disturbance and confusion.
What types of Alzheimer's disease are there? - Types of Alzheimer's disease include early onset Alzheimer's, late-onset Alzheimer's, and familial Alzheimer's disease (FAD).
What're the stages of Alzheimer's disease? - Stages of Alzheimer's disease include no cognitive impairment, mild cognitive decline, moderate cognitive decline, moderately severe cognitive decline...
What causes Alzheimer's disease? - The ultimate cause or causes of Alzheimer's disease are still unknown, there are several risk factors that increase a person's likelihood of developing the disease.
What're the risk factors for Alzheimer's disease? - The risk for Alzheimer's disease increases with age. People with a family history of Alzheimer's have a greater risk.
What're the warning signs of Alzheimer's disease? - The warning signs of Alzheimer's disease include memory loss, difficulty performing familiar tasks, problems with language, poor or decreased judgment.
What're the symptoms of Alzheimer's disease? - The symptoms of Alzheimer's disease include memory lapses, perform routine tasks, loss of judgment, and personality or behavior changes.
How is Alzheimer's disease diagnosed? - Diagnosis of Alzheimer's disease is complex. Diagnosis of Alzheimer's disease begins with a thorough physical exam and complete medical history.
What's the treatment for Alzheimer's disease? - Some treatments for Alzheimer's disease that can be used to help manage and ease the symptoms. Medications help alleviate the symptoms of depression, anxiety, and delusions.
What medications treat Alzheimer's disease? - Four medications, tacrine, donepezil, rivastigmine tartrate and galantamine, are used to improve intellectual function in some patients with Alzheimer's disease.
What's the dietary therapy for Alzheimer's disease? - Dietary therapy for Alzheimer's disease involves appropriate intake of darkly colored fruits and vegetables, soy, alcohol, folate and vitamin B12.
What's the exercise therapy for Alzheimer's disease? - Aerobic exercise is very important for helping to protect against mental decline during aging due to Alzheimer's disease.
What's the prognosis of Alzheimer's disease? - A person with Alzheimer's disease lives an average of eight years and as many as 20 years or more from the onset of symptoms.
What's vascular dementia? - Vascular dementia is a common form of dementia in older persons that is due to cerebrovascular disease, usually with stepwise deterioration.
What types of vascular dementia are there? - There are a number of different types of vascular dementia. Two of the most common are multi-infarct dementia, binswanger's disease.
What's multi-infarct dementia? - Multi-infarct dementia is the most common form of vascular dementia. Multi-infarct dementia is associated with atherosclerosis.
What is Binswanger's disease? - Binswanger's disease is a progressive neurological disorder characterized by injuries to the blood vessels supplying the deep white-matter of the brain.
What causes vascular dementia? - Vascular dementia can be caused in several different ways. Most commonly there is blockage of small blood vessels (arteries) deep within the brain.
What're risk factors for vascular dementia? - The risk factors for vascular dementia are high blood pressure, high cholesterol, diabetes and heart rhythm problems.
What're the symptoms of vascular dementia? - Symptoms of vascular dementia include memory loss, difficulty doing usual daily activities, and a tendency to wander.
How is vascular dementia diagnosed? - Vascular dementia is diagnosed based on history, symptoms, signs, and tests, and by ruling out other causes of dementia.
What's the treatment for vascular dementia? - Treatment of vascular dementia is aimed at reducing the risk factors including stroke, high blood pressure, diabetes, high cholesterol and heart disease.
What's lewy body dementia? - Lewy body dementia is a progressive cause of dementia characterised by both cognitive problems and motor impairments.
What causes lewy body dementia? - Lewy body dementia is caused by abnormal microscopic deposits of protein in nerve cells. Lewy bodies appear in deteriorating nerve cells.
What're the symptoms of lewy body dementia? - Symptoms of lewy body dementia include a gradual loss of mental abilities, including orientation and memory, reasoning and intelligence.
How is lewy body dementia diagnosed? - Lewy body dementia is diagnosed by taking a careful history of the pattern of symptoms, and by excluding other possible causes.
What's the treatment for lewy body dementia? - There's no specific treatment for lewy body dementia. Treatment is directed at managing the signs and symptoms of the disease.
What is Pick's disease? - Pick disease is a brain disorder that causes slowly worsening decline of mental abilities. Pick's disease is a less common type of dementia.
What causes Pick's disease? - Pick's disease is a rare disorder similar to senile dementia/Alzheimer's type. Behavioral changes are prominent with loss of inhibition.
What're the symptoms of Pick's disease? - The signs and symptoms of Pick's disease include loss of intellectual abilities and changes in behavior and personality.
How is Pick's disease diagnosed? - Diagnosis of Pick's disease is based on initial diagnosis on history and symptoms, signs, and tests, and by ruling out other causes of dementia.
What's the treatment for Pick's disease? - There is no proven effective treatment for Pick's disease. Monitoring and assistance with self-care may be required.