Treatment for dementia

Elder interview Gareth James from the Dementia and Disabilities Unit
The four most well-known types of dementia – Alzheimer’s disease, vascular dementia, dementia with Lewy Bodies, and Frontotemporal dementia, are all medically referred to as neurodegenerative dementias.

This means they are progressive and irreversible because of the extent of damage they cause to brain cells, and the connections between them.

However, with the right support and treatment people with dementia can still find enjoyment in life and spend meaningful time with loved ones.

There are a number of prescription medications, as well as non-drug treatments that are widely used to slow progression and manage symptoms. And, while there’s no cure yet, organisations such as Alzheimer’s Research UK are also constantly investigating new ways to treat and even prevent dementia too.

 

What to expect from your doctor

There are many things that can cause dementia like symptoms. Periods of memory loss can often be due to a lack of sleep, increased anxiety, and even certain medications. Becoming more forgetful can also be part of the normal ageing process too.

However if you’re over the age of 65 and find yourself  struggling with memory day to day, it’s important to speak to a doctor as soon as possible. This is especially important if you are also experiencing changes in the way you speak or behave. 

The earlier dementia is diagnosed the more likely it is that you’ll be able to start a treatment that may slow its progression. And, if its not dementia, your doctor will be able to check for other causes of your symptoms and rule out anything serious.

There’s not set test for diagnosing dementia – your GP is likely to do a range of medical tests and assessments to understand more about your cognitive function.  They’ll usually start by asking you more about your symptoms and the impact they are having on your daily activities.

This’ll likely be followed by an in-depth review of your family history, current health, and medications – including any vitamins or supplements you’re taking.

Some conditions can make symptoms of dementia worse, so understanding and treating these first is crucial. These often include conditions that affect your cardiovascular health such as high blood pressure and high cholesterol.

To rule out other causes of dementia-like symptoms your GP may also ask to run a few blood tests to check your liver function, kidney function, thyroid function, and vitamin B12 levels.

While dementia is usually diagnosed by specialists at a memory clinic, your GP will likely want to assess your memory, attention span and thinking skills before making a referral. They’ll do this by asking you to complete a pen and paper test called the General Practitioner Assessment of Cognition (GPCOG).

Once you’ve received a diagnosis of dementia, your GP practice will be able to suggest local support groups, or someone who can help you process the news too. Whether you’re facing feelings of anger, or are worried about what the future holds for you and your loved ones, this can be an important step in processing the news.

What is the first line treatment of dementia?

A person with dementia will usually be offered a combination of the following treatments after a diagnosis.

Medication 

There are three core types of medication used in the treatment of dementia symptoms – acetylcholinesterase inhibitors, Memantine, and antidepressants or antipsychotics. We’ll cover these in detail in the next section.

Complimentary therapies

A GP or occupational therapist may recommend a range of alternative therapies that can help manage the symptoms of dementia and may enhance daily life. However, it’s important to remember that everyone experiences dementia differently, so it may take some trial and error to find a therapy that benefits you, and that you enjoy.

In the mid to later stages of dementia activities such as reminiscence therapy and music therapy could bring a sense of calm and comfort. Looking at old photographs and mementos, or listening to a piece of music may help evoke important memories and ease agitation in dementia.

Other therapies such as massage and aromatherapy have been found to help some people relax, particularly in the middle stages.

Another therapy you may want to try is Maintenance Cognitive Stimulation Therapy (MCST). Age UK runs group sessions for one or two hours a week, across the UK. MCST has been proven to help memory and thinking skills through such things such as art, discussions and quizzes. As well as helping symptoms, many enjoy the sense of togetherness and new friendships that come with these sessions.

Physical activities such as yoga and walking can help with balance and coordination. This can be especially important for those with muscle stiffness or tremors that can come with Lewy body dementia.

Medical devices

Technology can play a part in managing life with dementia too. Electronic calendars and automatic pill dispensers can make it easier to stay on top of medication. If wandering or becoming lost is a worry, a personal GPS device or personal alarm can add an additional layer of peace of mind.

What are the 3 most commonly prescribed drugs for dementia?

The type of medicine you are prescribed will depend on the type of dementia you’ve been diagnosed with.

Acetylcholinesterase inhibitors

An acetylcholinesterase inhibitor prevents a substance in the brain called acetylcholine from breaking down. Acetylcholine is needed to help nerve cells communicate effectively – which is crucial for many functions including communication, co-ordination and memory.

They may sometimes be called a cholinesterase inhibitor – but are the same group of medicines.

Donepezil, rivastigmine and galantamine are the three core acetylcholinesterase inhibitors. They’re usually used as an effective treatment for the varying stages of Alzheimer’s – the most common form of dementia causing disease. They may also be prescribed to people living with Lewy body dementia, or  a mixed dementia diagnosis of both Alzheimer’s and vascular dementia.

Memantine

This medicine is given to people with moderate or severe dementia – again, specifically those living with Alzheimer’s disease. It is also prescribed to people with dementia with Lewy bodies and those with a combination of Alzheimer’s disease and vascular dementia.

Memantine is often used to manage symptoms in patients who are unable to take acetylcholinesterase inhibitors. It works by blocking the effect of glutamate in the brain, which can slow the progression of symptoms.

Antidepressants  or antipsychotics

While these medications don’t treat dementia, they can help with psychological symptoms such as anxiety and hallucinations.

Antipsychotic treatment is used when a dementia patient experiences challenging behaviour or is in mental distress. This usually culminates in behaviours such as increased agitation, wandering, aggressive behaviour and delusions.

The two antipsychotic drugs drugs prescribed to those living with dementia are called Risperidone and Haloperidol.

Both can be used for those with moderate to severe Alzheimer’s disease. However those with vascular dementia should only be prescribed Haloperidol, and always at the lowest possible dose for no longer than 6 weeks.

There is a risk factor associated with Risperidone too – while fairly rare, serious side effects can include confusion, a fast pulse, fainting, and breathing difficulties. Therefore the drug will only be prescribed if someone is believed to be a danger to themselves or others.

Depression in dementia can be fairly common too.

Antidepressants are usually only prescribed if you have a history of depression, and if your GP  believes it to be an underlying cause of any anxiety or worry you are experiencing.

What is the latest treatment for dementia?

Clinical studies in America have found a new drug called aducanumab to be effective in slowing the progression of Alzheimer’s disease. What makes aducanumab different to other drug treatments is that rather than blocking or inhibiting damaging substances in the brain, it actually targets the production. In this case, it targets amyloid –the brain protein that builds up in in the early stages of dementia.

Unfortunately aducanumab has not been approved or licensed for use in the UK, and more trails need to be done to investigate the benefits and potential long-term impacts of taking it. However, because of the way the drug works, this is still a huge breakthrough and has the potential to influence the development of other treatments being tested in clincial trials right now.

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