Seeking the right treatment for dementia

You have been told by your GP that you have dementia. What happens next? What treatments can help with the disease?

Although there is no cure for dementia, there are some drugs that may slow down progression of dementia or temporarily alleviate some of its symptoms. When seeking treatment for dementia, there are two symptoms that need to be treated. The first is treatment for memory loss and confusion and the second is treatment for behavioural issues that dementia can cause, such as depression, aggression and anxiety.

At present there are four medicines available. These include:

  • Donepezil (also known as Aricept)
  • Rivastigmine (also known as Exelon)
  • Galantamine (also known as Reminyl)
  • Memantine (also known as Ebixa)

The first three of these are called cholinesterase inhibitors and work by boosting levels of a chemical messenger in the body called acetylcholine (ACh). In theory, this improves communication between nerve cells. But there are side effects. These can include vomiting, nausea and diarrhoea. These medications are primarily used to treat Alzheimer’s disease, vascular dementia and Dementia with Lewy bodies.

Memantine works by regulating activity of glutamate, a chemical messenger involved in brain functions. Side effects can include dizziness, aggression, depression, headaches and sleepiness. This drug is only recommended by National Institute for Health and Care Excellence (NICE) for severe or moderately severe Alzheimer’s if a person is unable to tolerate cholinesterase inhibitors.

Before medications are prescribed, it should be determined that you should have had a proper diagnosis of dementia by a specialist. Your treatment should also be reviewed on a regular basis. The first prescription will be given by the specialist after a full assessment in a Memory Clinic (see below). In some areas of the country, once the patient has settled on the drug and if it seems to be helping, then their GP may be asked to take over prescribing. In other areas, the specialist prescribes medication.

In some cases, taking medications can improve memory for some people but others find the drugs offer no real benefit. All of these medications need to be taken daily. Symptoms can improve after three to six months in some cases.

You may also want to visit a Memory Clinic in your area for further support. Memory Clinics or Memory Services have been set up to provide treatment and support for those with dementia. They are run by health care and social care professionals. At the clinic, you will be offered an assessment to confirm that you have dementia. This may include memory tests, brain scans and blood tests. If you are confirmed to have dementia, staff will discuss treatment options and provide help and support on how you can manage and live with dementia. Ask your GP to refer you to a Memory Clinic in your area.

If you are unlikely to remember to take medications, then you may need someone, such as a family member or friend to prompt you to take them. If you are unsure whether you have taken your medication for the day then storing them a dosette box, (which has compartments for medications for each day of the week), will enable you to keep track of what you have taken. However, an easier option may be to speak to your pharmacist and ask if they can make-up blister packs so that you don’t have to worry about putting tablets into dosette boxes.

Other types of treatment that may help include therapy, such as counselling, psychotherapy and CBT – cognitive behavioural therapy.

Counselling – a person with dementia can talk to a counsellor who will listen to them in a non-judgemental way. Counselling can be in the form of individual or self-help group sessions.

Psychotherapy – this form of talking therapy means that the psychotherapist will aim to help you understand how your personality, beliefs and life experiences affect your behaviour. You may be able to change the way you think and become more positive.

Cognitive Behavioural Therapy – this is a form of psychotherapy that explores the link between thoughts, feelings and behaviour. It’s about developing a more positive mindset.
These therapies may help to reduce your anxiety or depression associated with your dementia diagnosis. Talk to your GP in the first instance if you would like to see a therapist. If you are offered therapy through the NHS, it will be free of charge but there may be a waiting list. You can also choose to have counselling privately and pay for it yourself. The British Association for Counselling (BACP) will provide more information on local counseling services. Visit http://www.bacp.co.uk

Having regular interaction and social contact with others can also help. Keeping your mind active by engaging in stimulating conversations with friends, getting involved in local activities and social groups can also help to keep your mind occupied, which may help to slow down the progression of dementia. Staying physically active and exercising regularly may also help.