What Treatment Is There For Dementia?

Since there currently is no cure for dementia, the focus is on two aspects: 1) slowing the progression; and 2) controlling the behaviors.


Slowing the progression.
Drugs (such as donepezil [Aricept] and memantine [Namenda]) increase neurotransmitters in the brain to hopefully improve memory and functioning. Although some studies statistically suggest a few patients may deteriorate more slowly for awhile, other studies showed there was no difference in patients ultimately needing nursing home care nor in progression of disability (requiring more help with bathing, dressing, eating, toileting). And, when side effects (such as nausea, diarrhea) and the cost of these medicines are also considered, there may be little meaningful benefit to taking them. But, because a few people may be helped, I suggest families try one of the above drugs for three months and if they see definite improvement, to continue it until a decline becomes obvious, then wean off it.


Controlling behaviors (agitation, anxiety, wandering, delusions).
Unrecognized pain may the culprit for several behaviors, particularly agitation.  Most seniors have chronic, arthritic pain, but with dementia they often can’t/won’t tell us they hurt and all we see is them being agitated.  Acetaminophen [Tylenol] or low dose morphine usually calms them better than anything else (minimizing medications and procedures also helps). Anti-depressants may help.   However, the antipsychotics (such as risperidone [Risperdal], haloperidol [Haldol]) rarely help and are not approved by the FDA for dementia. 

Next time I’ll discuss a philosophy of care for dementia.