Dementia Overview

Dementia Treatment and Prevention

The task of caring for a person with dementia usually falls to a close relative.
The task of caring for a person with dementia usually falls to a close relative.
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The progression of some types of dementia can be slowed with drugs, but dementia usually can't be reversed or completely stopped. Currently, the FDA has approved four drugs for persons with some forms of mild to moderate dementia; these drugs are known as cholinesterase inhibitors and consist of the drugs donepezil, galantamine, rivastigmine and tacrine.

These drugs work by suppressing cholinesterase, an enzyme which leads to the breakdown of acetylcholine. Acetylcholine helps transmit messages between neurons, an activity that is vital to learning new things and retaining memories. Memantine, a drug that works differently, was ecently approved by the FDA. Rather than inhibiting cholinesterase, memantine inhibits glutamate, which can cause neuron death when its receptors are overstimulated [source: Whitehouse].

Cholinesterase inhibitors aren't generally used, however, in treating vascular dementia. There is no drug treatment for vascular dementia, though some symptoms can be controlled. The progression of the disease can usually be slowed by treating some of the underlying risk factors for stroke. This means the patient may take medications to control high blood pressure or diabetes, as well as anticoagulants such as aspirin or warfarin. Lewy body dementia is usually treated with cholinesterase inhibitors in combination with Parkinson's medications and antipsychotic medications.

Since little can be done with drugs, the initial diagnosis of dementia may feel like a death sentence, one that's particularly slow and painful for the person involved and everyone around him or her. But it doesn't have to be. Patients with dementia should be encouraged to live normal lives and find ways to feel useful. However, because of the memory loss, these activities may have to be slightly amended. In the book "When a Family Member Has Dementia," author Susan McCurry describes a woman who realized that her mother didn't like sitting around being taken care of. Since her mother used to iron for hours, the woman provided her mother with an old iron with the cord cut off, so that the woman could "iron" without hurting herself [source: McCurry].

This example shows what a delicate dance caregiving for someone with dementia can be. In the early stages of dementia, the patient may be able to stay at home in familiar surroundings, with some safety modifications. As the dementia progresses, however, things may become more challenging for the caregiver. No two people with dementia are exactly alike, so there's no one book with all the answers. The patient may become more unpredictable and challenging, changing from one day to the next so that what worked yesterday won't work tomorrow. It may be a challenge for caregivers to remain resilient rather than resentful.

The physical, emotional and financial toll that caregiving can take is referred to as the caregiver burden. In some cases, the physical toll can be very real; a study found that the risk of death for a woman whose husband has dementia increases 28 percent in the first year after diagnosis, while it increases 22 percent for a husband with a diagnosed spouse [source: Britt]. About 90 percent of caregivers are wives, daughters and daughters-in-law, with spouses alone making up about half of all caregivers [source: Agronin]. It's important that these caregivers ask for help when needed and take care of themselves before trying to take care of others. One study showed that when people with dementia are cared for by people who feel stressed or burdened, then the patients exhibit more behavioral problems [source: Nagourney]. At some point, a nursing home may have to be considered.

Because there is no cure for dementia, the best thing to do is to try to prevent or delay it. While no one can stop the tides of aging or change the course of genetics, many of the risk factors are modifiable, including quitting smoking, maintaining a healthy weight and lowering cholesterol and blood pressure. Additionally, keeping the mind in fighting shape with mental challenges such as crosswords may also have an effect. To learn more tips, see the article "Can you delay dementia?" Additionally, there are several more articles and links for you to read below.

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  • Agronin, Marc E. "Dementia: A Practical Guide." Lippincott Williams & Wilkins. 2004.
  • Beers, Mark H., ed. "The Merck Manual of Medical Information. Second Home Edition." Merck Research Laboratories. 2003.
  • Britt, Robert Roy. "Risk of Death Can Soar When Spouse is Sick." Live Science. Feb. 15, 2006. (Sept. 3, 2008)
  • Judd, Sandra J., ed. "Brain Disorders Sourcebook, Second Edition." Health Reference Series. Omnigraphics. 2005.
  • McCurry, Susan M. "When a Family Member Has Dementia." Praeger. 2006.
  • Nagourney, Eric. "Troubled Helpers May Set Back Dementia Patients." New York Times. May 30, 2006. (Sept. 3, 2008)
  • Rabins, Peter V. "The Johns Hopkins White Papers: Memory." Johns Hopkins Medicine. 2007.
  • Rose, Steven. "The Future of the Brain: The Promise and Perils of Tomorrow's Neuroscience." Oxford University Press. 2005.
  • ­Whitehouse, Peter J. and Daniel George. "The Myth of Alzheimer's." St. Martin's Press. 2008.