Dementia (cont.)
Is There Any Treatment for Dementia?
While treatments to reverse or halt disease progression are not available for
most of the dementias, patients can benefit to some extent from treatment with
available medications and other measures, such as cognitive training.
Drugs to specifically treat AD and some other progressive dementias are now
available and are prescribed for many patients. Although these drugs do not halt
the disease or reverse existing brain damage, they can improve symptoms and slow
the progression of the disease. This may improve the patient's quality of life,
ease the burden on caregivers, and/or delay admission to a nursing home. Many
researchers are also examining whether these drugs may be useful for treating
other types of dementia.
Many people with dementia, particularly those in the early stages, may
benefit from practicing tasks designed to improve performance in specific
aspects of cognitive functioning. For example, people can sometimes be taught to
use memory aids, such as mnemonics, computerized recall devices, or note taking.
Behavior modification - rewarding appropriate or positive behavior and
ignoring inappropriate behavior - also may help control unacceptable or
dangerous behaviors.
Alzheimer's disease
Most of the drugs currently approved by the U. S. Food
and Drug Administration (FDA) for AD fall into a category called cholinesterase
inhibitors. These drugs slow the breakdown of the neurotransmitter
acetylcholine, which is reduced in the brains of people with AD. Acetylcholine
is important for the formation of memories and it is used in the hippocampus and
the cerebral cortex, two brain regions that are affected by AD. There are
currently four cholinesterase inhibitors approved for use in the United
States: tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Reminyl). These drugs temporarily improve or stabilize memory and
thinking skills in some individuals. Many studies have shown that cholinesterase
inhibitors help to slow the decline in mental functions associated with AD, and
that they can help reduce behavioral problems and improve the ability to perform
everyday tasks. However, none of these drugs can stop or reverse the course of
AD.
A fifth drug, memantine (Namenda), is also approved for use in the United
States. Unlike other drugs for AD, which affect acetylcholine levels, memantine
works by regulating the activity of a neurotransmitter called glutamate that plays a
role in learning and memory. Glutamate activity is often disrupted in AD.
Because this drug works differently from cholinesterase inhibitors, combining
memantine with other AD drugs may be more effective than any single therapy. One controlled clinical trial found that patients receiving donepezil
plus memantine had better cognition and other functions than patients receiving
donepezil alone.
Doctors may also prescribe other drugs, such as anticonvulsants, sedatives,
and antidepressants, to treat seizures, depression, agitation, sleep disorders,
and other specific problems that can be associated with dementia. In 2005,
research showed that use of "atypical" antipsychotic drugs such as olanzapine
and risperidone to treat
behavioral problems in elderly people with dementia was associated with an
elevated risk of death in these patients. Most of the deaths were caused by
heart problems or infections. The FDA has issued a public health
advisory to alert patients and their caregivers to this safety issue.
Vascular dementia
There is no standard drug treatment for vascular dementia, although some of
the symptoms, such as depression, can be treated. Most other treatments aim to
reduce the risk factors for further brain damage. However, some studies have
found that cholinesterase inhibitors, such as galantamine and other AD drugs,
can improve cognitive function and behavioral symptoms in patients with early
vascular dementia.
The progression of vascular dementia can often be slowed significantly or
halted if the underlying vascular risk factors for the disease are treated. To
prevent strokes and TIAs (transient
ischemic attack), doctors may prescribe medicines to control high blood
pressure, high cholesterol, heart disease, and diabetes. Doctors also sometimes
prescribe aspirin, warfarin, or other drugs to prevent clots from forming in
small blood vessels. When patients have blockages in blood vessels, doctors may
recommend surgical procedures, such as carotid endarterectomy, stenting, or
angioplasty, to restore the normal blood supply. Medications to relieve
restlessness or depression or to help patients sleep better may also be
prescribed.
Other dementias
Some studies have suggested that cholinesterase inhibitors, such as donepezil
(Aricept), can reduce behavioral symptoms in some patients with Parkinson's
dementia.
At present, no medications are approved specifically to treat or prevent FTD
and most other types of progressive dementia. However, sedatives,
antidepressants, and other medications may be useful in treating specific
symptoms and behavioral problems associated with these diseases.
Scientists continue to search for specific treatments to help people with
Lewy body dementia. Current treatment is symptomatic, often involving the use of
medication to control the parkinsonian and psychiatric symptoms. Although
antiparkinsonian medication may help reduce tremor and loss of
muscle movement,
it may worsen symptoms such as hallucinations and delusions. Also, drugs
prescribed for psychiatric symptoms may make the movement problems worse.
Several studies have suggested that cholinesterase inhibitors may be able to
improve cognitive function and behavioral symptoms in patients with Lewy body
disease.
There is no known treatment that can cure or control CJD. Current treatment
is aimed at alleviating symptoms and making the patient as comfortable as
possible. Opiate drugs can help relieve pain, and the drugs clonazepam and
sodium valproate may help relieve myoclonus. During later stages of the disease,
treatment focuses on supportive care, such as administering intravenous fluids
and changing the person's position frequently to prevent bedsores.
Next: Can Dementia be Prevented? »
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