Treatment Options For Dementia

In this post, I want to discuss treatment options for a person diagnosed with Dementia. By now, I hope that you have read the previous posts, including when memory changes are abnormal, different types of Dementia, and what a geriatric memory clinic evaluation entails.

A person who has been diagnosed with Dementia is often offered treatment options without medication use as well as options including medications.

One size does not fit all! Every person has individualized treatment.

Treatment Without Medicine

Patients with mild Dementia can have Cognitive rehabilitation. Usually, a trained speech therapist performs this type of therapy. A therapist helps patients learn to make connections and use techniques to compensate for any losses that interfere with daily life. Other treatment approaches include supportive group therapy, education regarding dementia diagnosis, and preparation for disease progression. Dementia experts also discuss environmental modifications that can keep people living at home independently for as long as possible, including supportive strategies such as clocks, calendars, to-do lists, visual cues, compassionate and straightforward communication skills.

Approved Medications for the Treatment of Dementia.

There are currently two types of approved medications that a doctor or health care provider may offer if you have been diagnosed with Dementia. These medications are prescribed depending on the type of Dementia, other medical histories, or allergy history. I am hopeful there will be more targeted treatment options in the coming years.

Cholinesterase Inhibitors are a class of medications approved for patients with mild to moderate Dementia. We are not exactly sure how these medications work. However, we think that they prevent the breakdown of a chemical in the body that helps with memory and thinking. These medications may also help with the behavioral symptoms of Dementia. Types of Cholinesterase Inhibitors include Aricept (donepezil), Exelon (Rivastigmine), and Razadyne (galantamine). The most common side effects include nausea, vomiting, diarrhea, muscle pain, and weight loss.

N-Methyl D- Aspartate (NMDA) antagonist, Namenda (memantine), is another type of approved medication for moderate to severe Dementia. This medication may help with memory, functioning, and behaviors. It is common for people to take this medication with a cholinesterase inhibitor. The most common side effect of this medication includes headache, confusion, diarrhea, constipation.

Other Medications Used to Treat Dementia Symptoms

Often people who have dementia experience symptoms that may need treatment with medications no approved for Dementia. Depending on the type of Dementia and severity of Dementia, common symptoms can include behavioral changes, depressed mood, anxiety, aggression, hallucinations, sleepiness, and insomnia.

Before starting a new medication, I review the current medication list and consider if the current medications could be causing a person's symptoms.

Common medications that can worsen symptoms of Dementia:

Diphenhydramine (Benadryl), Hydroxyzine (Atarax, Vistaril)
Meclizine (Antivert)
Oxybutynin (Ditropan) Tolterodine (Detrol), Fesoterodine (toviaz)
Promethazine (Phenergan)
Benzodiazepines used for anxiety, such as Alprazolam (Xanax), or Lorazepam (Ativan)
Many others! Geriatric doctors are particularly good at identifying medications that could be worsening symptoms of Dementia.

Medications used to treat Dementia symptoms, not approved by the FDA.

Doctors who take care of patients with Dementia sometimes use medications that are not approved for Dementia treatment; this practice is called "off-label use." The first approach is always to help a person with their symptoms without the use of medications. However, in some cases, the benefits of using medicine outweigh the risks. These symptoms can include depression, anger, agitation, physical violence, insomnia, etc.

The following medications are only for symptom management and are not FDA approved to treat Dementia. These medications can have severe side effects and interact with other disease processes and medicines. This is why it is crucial that the benefits of these medications outweigh their risks.

Antipsychotics - Commonly used for hallucinations, aggressive behaviors, sleep problems,
Antidepressants - Commonly used for depressed mood, anxiety, agitation, sleep issues
Mood stabilizers - Commonly used for agitation, aggressive behaviors, depressed mood.
Benzodiazepines - Commonly used for agitation, aggressive behavior, sleep problems, and anxiety.

A little About Melatonin

I like to use Melatonin when my patients have sleeping problems. Our body naturally produces Melatonin, and sometimes using 1-3mg earlier in the evening can help with sleep problems. It is much safer than using a prescribed medication. In some cases, such as liver disease, it may not be safe to take Melatonin. It is essential to discuss the use of Melatonin with your medical provider.