The treatment of dementia is a skill that is becoming more urgent for the primary care physician. While it is essential to treat dementia early, it is equally important to remember that one size does not fit all. For example, Aricept, a medication ideal for Alzheimer’s Disease (AD) may be detrimental for Frontotemporal Lobar Dementia (FTLD).
What follows is a Dementia Treatment Guide, a short description of the most common forms of dementia, and their treatments. This is meant to be a quick guide, not all-encompassing. Please read disclaimer before using this guide.
Alzheimer’s Disease (AD) – most common form of dementia, begins with memory loss followed by language difficulties. As AD progresses from mild to moderate, people lose executive function. Severe AD is characterized by imbalance, decreased movement and complete lack of communication.
AD Treatment:
Mild to moderate AD – acetylcholinesterase inhibitors (Aricept, Exelon, Razadyne)
Moderate to severe AD – Namenda
Research shows that targeted lifestyle choices can decrease cognitive decline associated with AD: elimination of simple carbohydrates and gluten, increased consumption of fruits and vegetables, fasting for 12 hours between dinner and breakfast, 7-8 hours of sleep each night, exercising 30 minutes a day 6 days a week, yoga, mediation and stress reduction.
Vascular Dementia (VD) – the second most common type of dementia characterized by a step-wise decline in memory and cognitive functioning caused by decreased blood flow to the brain due to strokes.
VD Treatment: stroke prevention to stop progression; lifestyle modifications to target heart disease, hypertension and diabetes; Namenda is both neuroprotective and improves cognition, preferred over Aricept.
Dementia with Lewy Bodies (DLB) – movement problems EARLY, memory problems LATER (opposite of AD); rapid progression; visual hallucinations; REM sleep disorder; 3-minute test to screen for LBD
DLB Tx: very responsive to Aricept and Exelon, for both memory and behavior; Klonopin for REM sleep disorder; extreme caution using anti-psychotics
Frontotemporal Lobar Dementia (FTLD) – strikes YOUNG people; memory normal in early stages, behavior and mood problems prominent, loss of impulse control; misdiagnosed as Bipolar Disorder; rapidly progressive
FTLD Tx: behavior problems – use Depakote, Tegretol; memory – use Namenda, AVOID Aricept and Exelon; speech therapy preserves function, avoid benzodiazepines
Parkinson’s Disease Dementia a (PPD) – 1 of 5 patients with Parkinson’s Disease gets PPD, 4 of 10 patients with PD get AD.
PPD Tx: Namenda or Aricept for memory, Aricept does not affect movement; extreme caution using anti-psychotics; use Seroquel if needed
Wernicke-Korsakoff Dementia - confabulation, often preceded by Wernicke’s encephalopathy which is characterized by confusion, ataxia and nystagmus. Caused by thiamine deficiency, which can result from alcohol dependence, eating disorders, AIDS, malnutrition.
WKD Tx: thiamine, Namenda, Aricept, Exelon. Namenda neuroprotective. Anti-psychotics do NOT decrease confabulation.
This Dementia Treatment Guide was originally created as a supplement for a CME course given at the Missouri Association of Osteopathic Physicians and Surgeons Annual Convention in Branson, Missouri on May 1, 2015.
Note: photos do not represent people with dementia; they are photos of actors and models, go to 123rf.com for information on releases and credits.
References:
10 Warning Signs of Alzheimer’s
Vascular Dementia: Signs, Symptoms and Treatment
Lewy Body Dementia Association
Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey
Poor Dental Health May Lead to Alzheimer’s Disease
Treatment of Frontotemporal Dementia
Clock-drawing: is it the ideal cognitive screening test?
Treatment of behavioral and psychological symptoms of AD with Yokukansan
Risperidone Versus Yokukansan in the Treatment of Severe Alzheimer’s Disease
Reversal of cognitive decline – a novel therapeutic program
Early diagnosis beneficial in AD
Appointment information for Dr. Micaela Wexler: wexlerpsych.com