Can medication help dementia?
Medication is generally used for two different reasons. Firstly, as treatment to help with symptoms that affect thinking and memory (cognitive symptoms). Secondly, as treatment to help with symptoms that affect mood and how someone behaves (non-cognitive symptoms).
These include donepezil, rivastigmine and galantamine. They work by increasing the level of acetylcholine. This is a chemical in the brain that is low in people with Alzheimer's disease. These medicines are not a cure for Alzheimer's disease. However, they may help to treat some of the symptoms affecting thinking and memory in about half of people with Alzheimer's disease.
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that donepezil, galantamine and rivastigmine can be considered as treatment options for people with mild or moderate Alzheimer's disease, providing that:
- The medicine is started by a specialist in the care of people with dementia.
- A person receiving treatment has regular reviews and assessments of their condition. (Reviews are usually carried out by a specialist team. Carers' views on the person's condition should also be asked before the medicine is started and should be considered during the reviews.)
- The medicine is only continued for as long as it is thought to be having a worthwhile effect on a person's symptoms.
Common side-effects of these medicines may include feeling sick, muscle cramps, tiredness, headache and diarrhoea. Your doctor should be able to give you more details about possible side-effects.
The medicine rivastigmine is also licensed to be used in people with mild-to-moderately severe dementia who also have Parkinson's disease. So, doctors may suggest this medicine for this group of people. Also, an acetylcholinesterase inhibitor medicine may sometimes be suggested for people with dementia with Lewy bodies (DLB) who have problems with challenging or disruptive behaviour (non-cognitive symptoms).
Memantine is also licensed for the treatment of Alzheimer's disease in some people. It works by reducing the amount of a brain chemical called glutamate. It is thought that this may help to slow down the damage to brain cells affected by Alzheimer's disease. Like the medicines above, this is not a cure. Some research studies have shown that it seems to slow down the progression of the symptoms in some cases.
NICE recommends that it can be considered as a treatment option for:
- People who have moderate Alzheimer's disease and who for some reason cannot take, or are intolerant to, the acetylcholinesterase inhibitor medicines.
- People who have severe Alzheimer's disease.
- An antidepressant may be advised if depression is suspected. Depression is common in people with dementia and may be overlooked.
- Aspirin and other medicines to treat the risk factors for stroke and heart disease may be appropriate for some people - especially those with vascular dementia.
- Sleeping tablets are sometimes needed if difficulty sleeping is a persistent problem.
- A tranquilliser or an antipsychotic medicine is sometimes prescribed as a last resort for people with dementia who become easily agitated. These medicines are not specifically licensed for dementia, and are only used where there is severe distress or risk of harm.
Research continues looking for new medicines to help with dementia.
What non-medicine treatment options are there?
Support and care is the most important part of treatment
When someone is diagnosed with dementia, a full assessment may be suggested to look at their practical skills, their ability to look after themself, their safety in their home, etc. This usually involves assessment by a number of different healthcare professionals. An individual care plan may be drawn up that outlines the person's specific needs. The aim is to maintain the independence of someone with dementia as much as possible and for as long as possible.
Most people with dementia are cared for in the community. Often, the main carer is a family member. It is important that carers get the full support and advice which is locally available. Support and advice may be needed from one or more of the following healthcare and allied professionals, depending on the severity of the dementia and the individual circumstances:
- District nurses can advise on day-to-day nursing care.
- Occupational therapists can advise on changes to the physical environment, which may help a person with dementia. For example, handrails and grab bars, labelling of objects, removing items that are not needed in the home.
- Physiotherapists can help. For example, with exercises to help maintain mobility.
- Community psychiatric nurses can advise on caring for people with mental illness. Sometimes a specialist assessment by a psychiatrist may be needed.
- Social Services can advise on local facilities such as daycare centres, benefits, help with care in the home, sitting services, respite care, etc.
- People who can advise on financial and legal matters, such as Lasting Power of Attorney.
- Voluntary organisations can be a good source of advice. If you care for a person with dementia, it is well worth getting information about the help that is available in your local area. In most areas of the UK there are organisations that provide support and advice for carers of people with dementia. Your local library or Citizens Advice Bureau will often have contact details.
The level of care and support needed often changes over time. For example, some people with mild dementia can cope well in their own home which is very familiar to them. Some may live with a family member who does most of the caring. If things become worse, a place in a residential or nursing home may be best. The situation can be reviewed from time to time to make sure the appropriate levels of care and support are provided.
Many carers struggle on beyond the point where they need more help. If you are a carer, you can ask a GP or district nurse to assess a person with dementia if you feel that you need a greater level of support. There are a number of local carer support groups on the internet, which may also be able to provide support and advice. For example, information about respite/short-break services for carers.
Other possible treatments
There are some other treatments and options that may be helpful for some people with dementia, particularly in certain situations. These include the following.
Measures to help simplify the daily routine and enhance memory may help some people. For example, planning out and writing down a daily routine. This may include writing reminders to do certain things such as putting the rubbish out, locking the door at night-time, etc. Making sure that clothing, keys, glasses or other things that are used often are put in prominent places where they can be found easily may also be helpful. Labelling of commonly used objects may be another useful tool. An occupational therapist may be able to advise.
Reality orientation is thought to help in some cases. This involves giving regular information to people with dementia about times, places, or people to keep them orientated. It may range from simple things, such as having a board in a prominent place, giving details of the day, date, season, etc, to staff in a residential home reorientating a person with dementia at each contact.
Cognitive stimulation (stimulating the brain) may help to improve memory, language and problem-solving ability. For example, by recreational activities, problem-solving activities and talking to the person with dementia. In addition, recreational activities may enhance quality of life and well-being.
Regular physical activity, if possible, such as walking, dancing, etc, may help to slow down the decline in mobility that is common in people with dementia. It may also help if depression is a problem.
Reminiscence therapy may help in some cases. This involves encouraging people to talk about the past so that past experiences are brought into their current thoughts. It relies on long-term memory which is often quite good in people with mild-to-moderate dementia.
Cognitive behavioural therapy is sometimes tried to help treat depression that is quite common in people with dementia.
Behavioural therapy may also be used to treat any problems related to behaviour that someone with dementia may have. This type of therapy looks for possible reasons for certain behaviours. For example, someone who wanders a lot may in fact be doing this because they are feeling quite restless. In this situation, taking part in regular physical activity may help.
Animal-assisted therapy may sometimes be suggested to help people with dementia who have challenging behaviour such as agitation or aggression. For example, allowing the person to spend time with and interact with a trained dog.
Sensory stimulation - for example, using music, lights, sounds, smells, massage and aromatherapy to stimulate the brain. This may also be helpful for some people with dementia - for example, to improve their mood or feelings of restlessness.
What is the law for driving?
In the UK, vehicle drivers who have been diagnosed with dementia are legally required to inform the Driver and Vehicle Licensing Agency (DVLA). They may be able to continue driving a car or a motorcycle safely for some time. But they may be asked to have a driving test and/or their doctor may be asked to complete a medical report for the DVLA. If someone is able to continue to drive, this will usually be reviewed on a yearly basis. Someone who has been diagnosed with dementia will not be able to continue to drive a bus (or other vehicle that carries passengers) or a lorry or large goods vehicle.
Further reading and references
Dementia; NICE CKS, August 2016 (UK access only)
Dementia Fact Sheet; World Health Organization (WHO), April 2016
Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease; NICE Technology Appraisal Guidance, March 2011
Guidelines for the diagnosis and management of Alzheimer's disease; European Federation of Neurological Societies (2010)
Robinson L, Tang E, Taylor JP; Dementia: timely diagnosis and early intervention. BMJ. 2015 Jun 16350:h3029. doi: 10.1136/bmj.h3029.
Dementia: Supporting people with dementia and their carers in health and social care; NICE Clinical Guideline (November 2006, last updated September 2016)
Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset; NICE Guidelines (October 2015)
Health matters: midlife approaches to reduce dementia risk; Public Health England Guidance, March 2016
Laver K, Dyer S, Whitehead C, et al; Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open. 2016 Apr 276(4):e010767. doi: 10.1136/bmjopen-2015-010767.
Howard R, McShane R, Lindesay J, et al; Donepezil and memantine for moderate-to-severe Alzheimer's disease. N Engl J Med. 2012 Mar 8366(10):893-903. doi: 10.1056/NEJMoa1106668.
Brechin D et al; Alternatives to antipsychotic medication: Psychological approaches in managing psychological and behavioural distress in people with dementia, The British Psychological Society, March 2013
Living with dementia - Planning ahead; Alzheimer's Society
Dementia; NICE Quality Standard, June 2010
Dementia: independence and wellbeing; NICE Quality Standard, April 2013
I`m a 45 years old male.For more then 18 month I`ve been noticing a decline io my cogniotive skills, especially when stressed. It all started in December 2014, suddenly I felt like I can`t focus...Rockers
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.