By Dr Ananya Mandal, MD
Treatment of dementia depends on the condition causing the dementia. In some patients treatment may not be possible and approaches are targeted to delay worsening of symptoms. In others, a cause of dementia may be identified and treated. There is growing evidence that some kinds of mental exercises can help dementia.
Conditions that can be amenable to appropriate therapies to reduce dementia include anemia, congestive heart failure, chronic obstructive pulmonary disease, reduced blood oxygen levels, depression, infections, nutritional deficiencies and thyroid disorders.
Medications or pharmacological measures
Sometimes medications and drugs may be used to control behavior problems and also to delay the progression of dementia. These include:
Antipsychotics – these drugs are used in several psychiatric disorders like bipolar disorders, schizophrenia etc. Drugs include haloperidol, risperidone, olanzapine etc.
Mood stabilizers – these are usually used in mood disorders like bipolar disorder, mania and depressive disorders. Drugs include fluoxetine, imipramine, lithium, citalopram and escitalopram etc.
Central nervous system stimulants like methylphenidate
Drugs to slow that progression of dementias include Donepezil (Aricept®), rivastigmine (Exelon®), galantamine (Razadyne®, formerly called Reminyl®) and Memantine (Namenda®). These are called cognitive enhancers. Of these acetyl cholinesterase inhibitors include Aricept or donepezil and glutamate blockers including memantine.
There are several psychological treatments that can be used in dementia. Group therapies usually do not help as they may raise levels of confusion. Some of the therapies used include:
Cognitive stimulation and reality orientation therapy – In this method activities and exercises that are designed to improve memory, skills and language ability are used. Reality orientation therapy is a part of this approach.
Behavioural therapy – this helps patients with behavioral problems including depression, aggression and delusional thinking. Behavioural therapy is usually provided by a carer and supervised by a health professional. Behavioural therapy uses a problem-solving approach.
Eye and ear tests
Checking on eyes and ears for development of hearing impairments and cataracts
Family support and dementia care
It is important that the person and their family is provided appropriate support to deal with dementia. Use of services of social worker, occupational therapist and a psychologist for the patient and care giver helps to a great extent.
The Department of Health has published a National Dementia Strategy for adequate dementia care. It focuses on raising awareness, early diagnosis and intervention. The condition should be detected as early as possible with accurate diagnosis given sensitively, immediate care and support following diagnosis and continuing support for people with dementia and their carers.
Maintenance of general health
Most dementia patients are elderly and susceptible to declining health due to lack of abilities to care for self and seek help. It is important to look after nutritional and other health needs of these patients. Medications are needed to control high blood pressure, high cholesterol, high blood sugar (in diabetes patients) and thyroid disorders.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)