Dementia

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Dementia Treatment

The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be needed for a short time. The underlying causes should be identified and treated, including treatment for reversible organic lesions such as tumors.

Stopping or changing medications that worsen confusion or that are not essential to the care of the person may improve cognitive function. Medications that contribute to confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and others.

Disorders that contribute to confusion should also be treated. These include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning.

Medications may be needed to control aggressive or agitated behaviors that are dangerous to the person with dementia or to others. These are usually given in very low doses and adjusted as necessary.

Possible medications for this use include the following:

• Anti-psychotics, given at night
• Serotonin-affecting drugs (trazodone, buspirone)
• Dopamine blockers (haloperidol, Risperidal, olanzapine, clozapine)
• Cholinesterase inhibitors [donepezil (aricept), rivastigmine (exelon), or the newly approved galantamine (reminyl) for Alzheimer's-type dementia]
• Fluoxetine, imipramine, or Celexa to help stabilize mood
• Stimulant drugs (such as methylphenidate) to increase activity and spontaneity
• Vitamin E

Sensory function should be evaluated regularly and hearing aids, glasses, or cataract surgery should be provided as needed.

Formal psychiatric treatment such as psychotherapy or group therapy is seldom helpful because it may overload the limited cognitive resources in the person with dementia.

LONG-TERM TREATMENT:

Providing a safe environment, controlling aggressive or agitated behavior, and meeting the physiologic needs of a person with dementia may require monitoring and assistance in the home or in an institutionalized setting. Possible options include in-home care, boarding homes, adult day care, and convalescent homes.

Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may help in caring for the person with dementia. In some communities, support groups may be available (see elder care - support group), and family counseling can help family members cope with home care.

In any care setting, there should be familiar objects and people. Lights can be left on at night to reduce disorientation. The activity schedule should be simple. Behavior modification may help some people to control unacceptable or dangerous behavior. This consists of rewarding appropriate behaviors and ignoring inappropriate ones (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may also help reduce disorientation.

Legal advice may be appropriate early in the course of the disorder, before the person with dementia becomes too incapacitated to make decisions. Advance directives, power of attorney, and other legal actions may make it easier to decide about the care of the person with dementia.