Dementia treatment

How is dementia treated?
Dementia is not curable but more and more drugs are coming on the market that can delay cognitive impairment.Two types of drugs are commonly prescribed.Cholinesterase inhibitors (Aricept, Exelon and Razadyne) prevent the breakdown of acetylcholine, a
neurotransmitter that is essential to memory and thought processes. These drugs are used to treat mild and moderate Alzheimer’s and can delay the progression of the disease up to a year. Only about half the people who have tried the drug have benefited. The other drug, memantine (Namenda), regulates glutamate, a different neurotransmitter. It is prescribed for patients with moderate to severe Alzheimer’s. It also delays the disease’s progression in some patients. Other symptoms such as restlessness, combativeness, hallucinations and delusions can be treated with behavior modification as well as medication. Caregivers need to be alert to things that trigger behavioral problems, such as a change in environment. The patient may be responding to an awareness of their diminishing abilities, or attempting to communicate some need. Patients should be checked for injuries, illness, drug interactions or side effects. Dementia also can change sleep patterns, which can affect mood.
A variety of anti-depressant, anti-anxiety and anti-psychotic drugs are available.

Are alternative treatments available?
A number of nutritional supplements are sometimes used to reduce dementia symptoms. Research on their effectiveness is limited and claims are mostly anecdotal. Some may have side effects or interfere with prescription medications. The manufacturing of these products is not regulated and so their quality and purity can vary widely. Before trying any of these products, research the product and manufacturers. You should also consult a Physician as some vitamins/herbal medication may interfere with prescribed drugs.
Vitamin E is sometimes prescribed because it is an antioxidant. It may help delay mental decline. However, in high doses, Vitamin E can interfere with medications including blood-clotting drugs.
Another antioxidant, Coenzyme Q10, or ubiquinone, sometimes is used to treat dementia. It occurs naturally in the body, but little is known about effective dosages or side effects.
Turmeric, the bright yellow seasoning in curries, also has shown to have antioxidant properties. Studies in rats have found that turmeric stimulates an enzyme called hemeoxygenase to act as a defense mechanism against free radicals, which are believed to be a factor in dementia.
The herb ginkgo biloba has been used for centuries by the Chinese to treat memory problems. It has antioxidant and anti-inflammatory properties.
Research has found that it can help with cognition and behavior, but it also can reduce the blood’s ability to clot. There is a lot of evidence that suggests ginkgo can help to reverse some of the memory difficulties of people with dementia – check with your Doctor before taking to make sure it doesn’t interfere with any other medication.
Another Chinese herb huperzine A has properties similar to cholinesterase inhibitors and is being tested in clinical trials. It has shown to be effective in small studies, but it is not known how it reacts with medications.
Omega-3 fatty acids are believed to reduce the risk of heart attack and stroke. Omega-3 also is shown to protect nerves and elevate mood. These fatty acids are found in fish and plants such as flax. The U.S. Food and Drug Administration recommends that no more than 3 grams be consumed. Since fish often are contaminated with mercury and other toxins, it is important to use pharmaceutical grade oil.
Phosphatidylserine is a type of lipid that makes up the membranes around nerve cells. Since these membranes deteriorate in dementia, it is believed that phosphatidylserine may help slow the progression of the disease. However, little official research has been done. B vitamins are vital for mental health and a deficiency in any of these will rapidly affect how someone thinks and feels. Because B vitamins are water soluble you need to make sure you get a daily intake, either from food or taking vitamin supplements.

Do mental exercises help?
All kinds of exercise help the brain – physical, mental and social. It’s a case of use it or lose it. Several studies have found that physically exercising at least twice a week can reduce the risk of developing dementia by between 40 and 60 percent.
Researchers recommend a 20-minute walk twice a day as a way to increase blood flow to the brain.
Mental exercises such as solving puzzles or pursuing hobbies help stimulate the brain. It’s probably best to stick to familiar activities like crosswords and jigsaw puzzles. People with dementia find it harder to learn new things and if they’re not used to puzzles like Sudoku, may find it difficult to master!
Cognitive Stimulation Therapy (CST) has been shown to have a positive effect on dementia sufferers. CST consists of activities like word games, reality orientation and other information processing activities. It's been shown to improve cognitive ability and quality of life for participants.
Contact your local support group or speak to your physician about whether this is available in your area.
Social interaction also is valuable. It stimulates the brain and improves emotional health. Having friends and family visit or phone on a regular basis is a good way of ensuring the dementia patient gets adequate social contact.
And, finally, good nutrition is important. A diet with lots of fresh fruits and vegetables is good for the whole body.

What are the care options?
Dementia is a progressive disease and the types of care required will change as the disease changes.
Many families try to care for their loved one at home, which can be very challenging. In the early stage of the disease, the patient will have lucid times and confused times. A familiar face often is reassuring. But homecare requires a support network of family and friends to provide respite for the caregiver. Some visiting nurse agencies now provide nursing and personal care services for dementia patients.
Assisted living facilities are becoming a popular choice. Many of these facilities offer several levels of care so the patient’s needs can be addressed in one place. Often the spouse can live at the facility with the patient and can participate in their care without bearing the full brunt of it. These facilities provide food, laundry, maid, personal hygiene and nursing services. Many of them cater to Alzheimer’s patients and offer recreation and other stimulating activities.
Nursing homes often become necessary in the late stage of the disease as the patient loses the ability to care for themselves or communicate with others.

What to do in the early stages of dementia
Candid conversations on a variety of subjects are important in the early phases. Sit down with family, close friends and a trusted financial adviser to talk about the financial situation.
Set up direct deposit of checks and direct payment of bills, and make sure someone is double-checking that nothing falls through the cracks.
Consider establishing a joint bank account.
Check insurance policies so that everyone knows what medical and long term care options are available.
Consult with a lawyer about power of attorney, guardianships and other legal avenues for caregivers. This also is a good time to update wills and living wills to make wishes known about end of life care.
Let people around you know what is happening. A neighbor, the mailman or the gardener can be alert to problems. And get acquainted with services available in your community such as respite care and adult day care.
Write it down - in the early phases of dementia, it can be helpful to post a daily schedule, including meals and medication times, to help the patient keep track of their day. You could use an erasable white board placed somewhere prominent, such as the kitchen.
Be aware that early on the patient wants to stay as independent as possible and may become hostile or sullen if they feel people are trying to take over their life. Make sure you allow them to be as independent as possible.

Keeping their long-term memory
Being surrounded by familiar possessions can be a comforting thing early on but later as cognition begins to decline, too many objects can be confusing.
There will come a time when the patient’s environment needs to be simplified.
A few family photos, labelled with names, can help stimulate the memory. But a treasured collection of porcelain figurines should probably be put out of harm’s way. Throw rugs and electrical wires should be eliminated from frequently travelled areas.
Use what’s known as “Reminiscence therapy”. This is where you help to stimulate your loved one’s long term memory by showing them pictures, or objects from the past. Or talk to them about past events. Additionally, you could use music, videotapes etc. You’ll find when it comes to talking about their younger days; most dementia patients’ memories are as good as ours!
Rather than starting your loved one on new hobbies or tasks, try to stick to familiar tasks that they can do almost automatically – without having to think about it. This could be things like; folding laundry, making beds, setting out cutlery, gardening, washing and drying plates and the like. This makes it more likely that they’ll be able to remember what to do and in carrying out the task successfully, they’ll feel satisfied that they’re being useful.

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