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.
Mild to moderate AD – acetylcholinesterase inhibitors (Aricept, Exelon, Razadyne)
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.
Results of a large, federally funded trial showed that 10 milligrams of donepezil (Aricept) daily reduced the risk of progressing from amnestic MCI to Alzheimer’s disease for about a year, but the benefit disappeared within three years.