Most types of dementia are progressive and cannot be cured. However, there are some exceptions, including dementia caused by vitamin and thyroid hormone deficiences, which can be treated with supplements. Some causes can be treated surgically, for example, some brain tumours, excess fluid on the brain (hydrocephalus) or head injury. For neurodegenerative types of dementia, it is important to prevent additional damage by modifying risk factors, such as treating high blood pressure, high cholesterol, type 1 diabetes, and stopping smoking.
For dementia that cannot be cured, such as Alzheimer’s disease, medicines can be prescribed that may prevent symptoms getting worse for a period of time. These are generally prescribed to people in the early and middle stages of the disease.
It is fairly common for people with dementia to have depression as well. There are many treatments for this. Therefore, your GP may consider prescribing an antidepressant medication. They may consult a specialist or psychiatrist who works with old people.
Perhaps the most important type of treatment is support and care. If you or a loved one have been diagnosed with dementia, you should start planning the care that will be required in the future. Discuss the options with the people concerned – your family, your GP and your local authority. The Alzheimer’s Society is also a valuable source of information and support. It has branches in England, Ireland and Wales.
Finally, there are things you or your loved one can do to maintain memory, independence and function.
Medication for dementia
A number of different medications have been shown to be effective in treating mild, moderate and severe dementia. Depending on the underlying diagnosis, severity of the condition, or any other issues observed by the doctor, you may be prescribed medications. However, not everybody will benefit from these drugs.
Acetylcholinesterase inhibitors (such as Donepezil, Galantamine, and Rivastigmine) are licensed to treat mild to moderate Alzheimer’s disease. They can also be used to treat people with dementia with Lewy bodies, and can be particularly effective at treating hallucinations.
Nausea and vomiting are the most common side effects of acetylcholinesterase inhibitors. However, this should settle down within the first two weeks of taking the medication.
Sometimes, acetylcholinesterase inhibitors can also slow down your heartbeat, so you may need to have an electrocardiogram (ECG) both before and during treatment. An ECG is a procedure that records the rhythms and electrical activity of your heart.
Memantine hydrochloride is a medication that works by blocking the effects of a chemical in the brain. It is licensed to treat severe Alzheimer’s disease, but can also be used to treat moderate cases where someone does not respond well to acetylcholinesterase inhibitors.
Antipsychotics are medicines that can be used to treat challenging and disruptive behaviour, such as aggression or agitation. However, they are used with caution and usually for short periods because they can:
- increase the risk of a person experiencing cardiovascular diseases, such as stroke or heart attack
- make other symptoms of dementia worse and cause drowsiness.
Also, in people who have dementia with Lewy bodies, there is evidence that antipsychotics can cause a range of serious side effects, including:
- inability to communicate
Therefore, in most cases antipsychotics are only used when there are severe symptoms of challenging and disruptive behaviour that pose a risk of harm. They will only be used following a full discussion about the benefits and risks of treatment with the person being prescribed the drugs, their carer and the relevant care team.
If antipsychotics are used, they will be prescribed at the lowest possible dose and for the shortest possible time. The health of someone taking antipsychotics will also need to be carefully monitored.
Possible side effects of antipsychotics can include:
- muscle twitches
- weight gain
- blurred vision
- lack of sex drive
- dry mouth
It is not uncommon for someone with dementia to become depressed (feeling persistently low or sad). Depression can sometimes make the memory of a person with dementia worse. Antidepressants may be prescribed to treat depression.
Psychological treatments for dementia
Psychological treatments do not slow down the progression of dementia, but they can help with coping with the symptoms. Some psychological treatments are outlined below.
Cognitive stimulation and reality orientation therapy
Cognitive stimulation involves taking part in activities and exercises designed to improve memory, problem-solving skills and language ability.
Reality orientation therapy is a type of therapy that reduces feelings of mental disorientation, memory loss and confusion, while improving feelings of self-esteem.
The therapy may involve group work in a classroom, in which a board prominently displays information such as:
- the current day and date
- the location of the classroom
- the names of the people in the group
The group members repeat a series of tasks designed to give mental stimulation. The tasks also reinforce information regarding the time, the place and the people involved in the group. There will be discussions about a variety of topics, as well as word and memory games.
Reality orientation may be beneficial in some cases, but the benefits can be small and are often only apparent with continued effort. The technique is also often considered unsuitable for use in care home settings.
The aim of validation therapy is to explore what things were like for the person with dementia in the past and how this relates to the way they are feeling now. It works on the principle that even the most confused behaviour has some meaning for the person with dementia.
For example, if a person with dementia talks about wanting to go home to see their husband or wife who has previously died, telling them that their partner is no longer alive may not be the best course of action and may confuse and upset them further.
Validation therapy is sometimes felt to be a better form of psychological therapy than cognitive stimulation and reality orientation therapy for treating dementia. This is because it focuses on the condition from an emotional, rather than factual, perspective. It views ‘confused talk’ as reflecting the emotional meaning of past events.
Behavioural therapy tries to find reasons for difficult behaviour. Different strategies are adopted to try to change that behaviour.
For example, a person with dementia may have a history of wandering out of their home or care centre because they feel restless. Therefore, encouraging them to take part in regular physical exercise may help to decrease their restlessness.
Behavioural therapy can be used to treat many of the behavioural problems that are associated with dementia, such as depression, aggression and delusional thinking. It is usually given by a carer, such as a trained friend or relative, or by an employed carer. It is supervised by a healthcare professional.