Dementia Treatment: Medication and Other Interventions Can Improve Quality of Life

Different types of dementia respond to different treatments. While none can cure the underlying brain disorders or significantly slow their progression, both drug and nondrug interventions can help reduce symptoms and improve a patient’s quality of life.

造成治疗一般的第一行defense forpeople with dementia. Commonly prescribed nondrug therapies include:

• Talk therapy, such as sessions with a mental health counselor or meetings with a support group, to cope with the emotional challenges of this diagnosis
• Cognitive behavioral therapy, to counterdepression and anxiety
• Cognitive stimulation therapy, to keep the mind active with themed activity sessions
• Cognitive rehabilitation, to relearn lost skills or develop new compensating skills
• “Life story work” that involves telling or documenting personal experiences and memories, to improve mood, well-being, and mental function
• Singing, dancing, art, and other activities that keep patients physically, mentally, and socially engaged, to boost confidence and cognitive skills and lower anxiety (1)

Drug Therapies May Be Used, Too

Doctors may prescribe one of the FDA-approved drugs for Alzheimer’s disease to treat otherforms of dementia.

Cholinesterase inhibitors are one example. They are a category of medication that includesAricept (donepezil),Exelon (rivastigmine),andRazadyne (galantamine).

By boosting levels of certainneurotransmitters(chemical messengers in the brain), these drugs help Alzheimer’s patients who are experiencing mild to moderate problems with memory, motivation, or concentration and are struggling to meet the demands of daily living.

Cholinesterase inhibitors are also commonly prescribed to people with Lewy body dementia to help with disturbing hallucinations or troubling behaviors.

Some researchers believe that people with Lewy body dementia may see even more improvement than patients with Alzheimer’s. (2)

Doctors may also prescribe a wide array of other kinds of medication, ranging fromantidepressantsand sleeping aids toantipsychotics. But not all of these drugs help manage all types of dementia, and some can have severe side effects.

Vascular Dementia: Treating Cardiovascular Issues Helps

Managing the cardiovascular problems that underlie vascular dementia can potentially slow its progress.

Physicians may prescribe medication to protect the heart and blood vessels, helping prevent further blockages that can starve brain cells of oxygen and cause further damage. Depending on the specifics of each person’s condition, doctors may prescribe drugs that can:

• Reduce blood pressure
• Reduce cholesterol
• Prevent blood clotting
• Help control blood sugar (for diabetics) (3)

Several research studies have looked at whether cholinesterase inhibitors can reduce symptoms of vascular dementia. According to the Alzheimer’s Society, benefits were found to be small (if measurable at all) and limited to people with mixed dementia who had both vascular dementia and Alzheimer’s. (4)

A healthy lifestyle can benefit people with vascular dementia. Physicians generally advise patients to get regular exercise,quit smoking, eat a healthy diet, maintain a healthy weight, and watch their alcohol intake. (5)

Treating Lewy Body Dementia Requires a Team Approach

Lewy body dementia, a category that included Parkinson’s dementia, is a complex disease involving thinking, memory, moving, sleep, and behavior as well as autonomic body functions — the Lewy Body Dementia Association calls it a “multi-system disease” — and finding the right treatment can require a team of physicians. (6)

People with Lewy body dementia may also benefit from working with the following kinds of therapists:

• Physical therapists, to address movement issues through cardiovascular, strengthening, and flexibility exercises
• Speech therapists, to help manage problems having to do with low voice volume, voice projection, or swallowing
• Music or expressive arts therapists, to help patients manage anxiety and enhance overall well-being
• Mental health counselors, to help patients and their families cope with the emotional challenges of thisdementia diagnosis
• Occupational therapists, to help develop strategies for everyday tasks, like bathing and eating
• Palliative care specialists, to improve quality of life by suggesting ways to relieve symptoms

Medication can also help, although some patients are exceptionally sensitive or may have a negative response to certain drugs.

Cholinesterase inhibitors, approved by the FDA to treat Alzheimer’s, can help with the cognitivesymptoms of Lewy body dementia.

They may also help reduce hallucinations and delusions, although doctors warn the drugs take time to kick in, can cause side effects like nausea, and aren’t always effective.

The FDA has approved a single Alzheimer’s drug,Exelon (rivastigmine), to treat one form of Lewy body dementia, Parkinson’s dementia. While it can boost cognitive function, it too has side effects.

For patients having movement-related symptoms, doctors may recommend a Parkinson’s medication called carbidopa-levodopa (Sinemet、Parcopa Stalevo)。但由于事后s side effects, like hallucinations and delusions, physicians prescribe this drug with caution.

One common symptom of Lewy body dementia is REM sleep behavior disorder, in which patients physically act out their dreams. Klonopin (clonazepam), a drug used for seizures andpanic attacks, can reduce this symptom at very low doses. Side effects can include dizziness, unsteadiness, and cognitive problems. The sleep hormonemelatoninmay also help, on its own or in combination with clonazepam.

Traditional (typical) antipsychotic medication can be dangerous for people with Lewy body dementia; drugs such as Haldol (haloperidol) can result in severe confusion, extremeParkinsonism, sedation, even death. Physicians may prescribe so-called atypical antipsychotic drugs at low doses for a limited time. (7)

Treatment for Frontotemporal Disorders

As with Lewy body dementia, frontotemporal disorders, also known asfrontotemporal dementia, are complicated and potentially involve a team of medical experts as well as speech, language, and occupational therapists.

Certain antidepressants, such astrazodone, may somewhat relieve behavioral symptoms, such as social disinhibitions and impulsive behavior.Selective serotonin reuptake inhibitors (SSRIs), such asZoloft (sertraline)andLuvox (fluvoxamine), may also help.

As with Lewy body dementia, doctors need to prescribe antipsychotics with caution. (8)

Cholinesterase inhibitors have been studied in clinical trials to see if they might be effective in treating frontotemporal disorders. Results have been mixed. In some cases, these drugs have made symptoms worse. (9)