Pharmacologic Treatment of Dementia

Dementia is a set of neurological symptoms, not an actual disease. Understanding what causes dementia is the first step toward treatment. The most common forms are Alzheimer's and vascular dementia. There is a preconceived notion that as a person grows older, significant memory loss is inevitable. Moderate to severe memory loss is not a normal sign of aging. If you or someone you love has been diagnosed with a form of dementia, there are treatment options available.

Pharmacologic Therapy

• Pharmacologic therapy is the most common option for these disorders, slowing the progression of the disease process and increasing the individual's quality of life.
  Cholinesterase inhibitors--donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Reminy®)--are a group of drugs used during the early to middle stages of Alzheimer's. The earlier these medications are started, the greater the benefit to the patient.

  These medications stabilize the symptoms. The symptoms will continue to worsen, but at a slower rate than if the medication was not present. Once these medications are started, they should not be discontinued.

NMDA Receptor Antagonist

• Namenda is the first NMDA receptor antagonist developed for Alzheimer's patients not only newly diagnosed but for severe cases. Unlike the cholinesterase inhibitors, Namenda doesn't slow the progression of the disease, but does help to improve the individual's memory and ability to perform day-to-day functions and activities.

  NMDA receptor antagonists decrease the amount of a chemical called glutamate. Too much glutamate in the brain causes decreased recall, learning and attention span.
  NMDA receptor antagonists can be used alone or in conjunction with cholinesterase inhibitors for the best possible outcome.

Antihypertensives & Statins

• Individuals diagnosed with vascular dementia may be given antihypertensives and statins (cholesterol reducing drugs) to help prevent future heart damage and stroke, which can lead to further brain dysfunction. Antihypertensives lower blood pressure and reduce the risk of stroke and heart disease. Blood clots, which can form in the arterial vessels secondary to hypertension, are the leading cause of vascular dementia, causing a decrease in blood flow to the brain resulting in cell death. These medications cannot reverse the effects of cellular death caused by blood clots, but they can help prevent further brain destruction.

  Plaque built up in the arterial walls caused by high cholesterol can also block the vessels, preventing precious oxygen from reaching the brain. Statins may also be administered to prevent plaque buildup.

Selective Serotonin Reuptake Inhibitors & Antipsychotics

• Selective Serotonin Reuptake Inhibitors (SSRIs) are often prescribed for depression, which is common in those diagnosed with dementia. Antidepressants, such as Prozac and Celexa, have the fewest side effects for most, and are beneficial for stabilizing the individual's mood.

  During the latent stages of dementia, some patient show signs of severe agitation, aggression, hallucinations and anxiety. Antipsychotics such as Risperdal and Zyprexa may be prescribed to treat these unfortunate symptoms. These medications have risk factors that must be discussed with the physician.

Preparation

• Dementia-related disorders are devastating diagnoses for any individual or family. Education is crucial for family members and caregivers. Those who have a loved one suffering from dementia can take advantage of many resources and support groups that can assist in making critical decisions and planning strategies during the transitions of this disease process. Putting these resources in place will provide the family and the diagnosed individual respite from the overwhelming changes in their uncertain future.