How is dementia treated?

Most types of dementia cannot be cured and will gradually cause more severe problems.

But there are important exceptions, including dementia caused by vitamin and thyroid hormone deficiencies, which can be treated with supplements.

Some causes can be treated surgically – for example, some brain tumours, excess fluid on the brain (hydrocephalus) or head injury.

For types of dementia that involve degeneration of nerve and brain tissue, you can take action to prevent further damage. It's possible to do this by reducing dementia risk factors, such as by managing high blood pressure, high cholesterol, type 1 diabetes and stopping smoking.

For dementia that currently cannot be cured, some types of medicine may prevent symptoms getting worse for a period of time. These medicines are usually given to people in the early and middle stages of the disease, to try to maintain or improve their independence.

It is fairly common for people with dementia to have depression. If you have dementia and depression, your GP may consider prescribing an antidepressant medication, or get you an appointment with a psychiatrist who specialises in working with older people.

Perhaps the most important type of treatment for anyone with dementia is the care and support they receive from healthcare professionals, family and friends.

If you or a loved one have been diagnosed with dementia, you should start planning the future care that will be required.

Discuss the options, such as Power of Attorney, with the people concerned – your family, your GP and your local authority. The Alzheimer’s Society is also a valuable source of information and support. It has branches in England, Ireland and Wales.

Finally, there are things you or your loved one can do to maintain memory, independence and function when you have dementia.

Medicines to treat dementia

A number of medications have been shown to be effective in treating mild, moderate and severe dementia. Depending on the particular type of dementia, the severity of the condition, or any other issues observed by the doctor, you may be prescribed medications. However, not everyone will benefit from these drugs.

Aricept (donepezil) and other acetylcholinesterase inhibitors

Acetylcholinesterase inhibitors (such as galantamine, and rivastigmine) are used to treat mild to moderate Alzheimer’s disease. They can also be used to treat dementia with Lewy bodies, and can be particularly effective at treating hallucinations.

Common side effects of acetylcholinesterase inhibitors include nausea and vomiting, but these usually get better after two weeks of taking the medication.

Acetylcholinesterase inhibitors can sometimes slow down your heartbeat, so you may need to have an electrocardiogram (ECG) both before and during treatment. An ECG is a procedure that records the rhythms and electrical activity of your heart.

Memantine hydrochloride

Memantine is a medicine that works by blocking the effects of a chemical in the brain. It is used to treat severe Alzheimer’s disease, but can also be given to people with moderate symptoms if they don't respond well to acetylcholinesterase inhibitors.

Antipsychotics

Antipsychotics are medicines that are sometimes used to treat people who's behaviour is disruptive – for example, they tend to become aggressive or agitated. They are normally used for a short period of time and with caution, because they can increase the risk of cardiovascular problems, cause drowsiness and tend to make other symptoms of dementia worse.

There is some evidence that antipsychotics can cause a range of serious side effects for people who have dementia with Lewy bodies. These include:

• rigidity
• immobility
• inability to communicate

In most cases, antipsychotics are only used when there are severe symptoms of challenging and disruptive behaviour that pose harm. Before being given antipsychotic drugs, the benefits and risks of treatment should be fully discussed between health and care professionals, family carers, and, if possible, with the person being prescribed the drugs.

If antipsychotics are used, they will be prescribed at the lowest possible dose and for the shortest possible time. The health of anyone taking antipsychotics needs to be carefully monitored.

Antidepressants

Depression is an issue for many people with dementia, perhaps linked with frustrations caused by the condition.

Depression can sometimes make the memory of a person with dementia worse. Antidepressants may be prescribed.

Psychological treatments for dementia

Psychological treatments do not slow down the progression of dementia, but they can help with the symptoms.

Cognitive stimulation and reality orientation therapy

Cognitive stimulation involves taking part in activities and exercises designed to improve memory, problem-solving skills and language ability.

Reality orientation therapy reduces feelings of mental disorientation, memory loss and confusion, while improving self-esteem.

Evidence suggests that cognitive stimulation can improve thinking and memory skills in people with dementia. It is currently the only psychological treatment directly recommended by the National Institute for Health and Care Excellence (NICE) to help people with mild or moderate dementia.

Reality orientation may also be beneficial in some cases, but the benefits can be small and are often only apparent with continued effort.

Validation therapy

Validation therapy focuses on dementia from an emotional, rather than factual, perspective. It is based on the principle that even the most confused behaviour has some meaning for the person.

For example, if someone with dementia becomes agitated at a certain point every day because they believe their mother is going to come and pick them up, telling them that their mother is no longer alive could cause them to become more agitated and distressed.

With validation therapy, the response to this situation might involve not correcting the person and accepting their concerns, but talking to them about the issue and gradually steering the conversation in another direction. In theory, this should reduce their distress, while acknowledging that their thoughts and feelings have meaning for them.

However, while validation therapy may sometimes be used as part of the treatment of someone with dementia, there is not enough evidence about the effectiveness of this approach to be certain whether it is beneficial.

Behavioural therapy

Behavioural therapy tries to find reasons for difficult behaviour. Different strategies are adopted to try to change that behaviour.

For example, a person with dementia may have a history of wandering out of their home or care centre because they feel restless. Therefore, encouraging them to take part in regular physical exercise may help to decrease their restlessness.

Behavioural therapy can be used to treat many of the behavioural problems that are associated with dementia, such as depression, aggression and delusional thinking. Behavioural therapy is often given by a trained friend or relative (usually the main family carer), or by an employed carer, but is supervised by a healthcare professional.