Stanford Center for Memory Disorders

Treatment Options

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 Alzheimer's disease 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 Alzheimer's disease 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 Alzheimer's disease. 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 Alzheimer's disease. There are currently four cholinesterase inhibitors approved for use in the United States: donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne). 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 Alzheimer's disease, 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 Alzheimer's disease.

Another drug, memantine (Namenda), is also approved for use in the United States. Unlike other drugs for Alzheimer's disease, 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 Alzheimer's disease. Because this drug works differently from cholinesterase inhibitors, combining memantine with other Alzheimer's disease drugs may be more effective than any single therapy. Some controlled clinical trials support the notion that patients receiving donepezil plus memantine had better cognition and other functions than patients receiving donepezil alone, while other studies are more ambivalent about any additional benefit.

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 risperdone 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 Alzheimer's disease 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, 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. Scientists continue to search for specific treatments to help people with Dementia with Lewy Bodies (DLB) or Parkinsonís disease dementia, two related disorders. 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 DLB. Donepezil (Aricept) can reduce psychiatric features and help with attention and memory.

At present, no medications are approved specifically to treat or prevent frontotemporal dementia and most other types of progressive dementia. However, antidepressants and other medications may be useful in treating specific symptoms and behavioral problems associated with these diseases.

There is no known treatment that can cure or control Creutzfeldt-Jakob disease. 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.

Frontotemporal dementia. There are no specific treatments available. However, anti-depressants can be used to help with behavioral modification.

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