Medications and Cognitive Training for Dementia
Cognitive Training as Part of Dementia TreatmentAs part of treating dementia, many people with the condition, particularly those in the early stages, may benefit from practicing tasks designed to improve performance in specific aspects of cognitive functioning. For example, people with dementia can sometimes learn to use memory aids, such as mnemonics, computerized recall devices, or note taking. Behavior modification -- rewarding appropriate or positive behavior and ignoring inappropriate behavior -- may also help control unacceptable or dangerous behaviors.
Family members and friends can also assist people with dementia in continuing their daily routines, physical activities, and social contacts. People with this condition should be kept up-to-date about the details of their lives, such as the time of day, where they live, and what is happening at home or in the world. Memory aids may help in the day-to-day lives of people in the earlier stages of dementia. Some families find that a big calendar, a list of daily plans, notes about simple safety measures, and written directions describing how to use common household items are useful aids.
Most of the medicines currently approved by the U.S. Food and Drug Administration (FDA) for Alzheimer's disease fall into a category called cholinesterase inhibitors. These medicines slow down the breakdown of the neurotransmitter acetylcholine, which is reduced in the brains of people with Alzheimer's disease. Acetylcholine is important for the formation of memories, and it is used in the hippocampus and the cerebral cortex, two brain regions that are affected by Alzheimer's disease.
At this time, four cholinesterase inhibitors are approved for use in the United States:
These Alzheimer's disease medications temporarily improve or stabilize memory and thinking skills in some individuals. Many studies have shown that cholinesterase inhibitors help to slow down the decline in mental functions associated with Alzheimer's disease and that they can help reduce behavioral problems and improve the ability to perform everyday tasks. However, none of these drugs can stop or reverse the course of Alzheimer's disease.
A fifth drug, memantine (Namenda®, Namenda XR®), is also approved for use in the United States. Unlike other drugs for Alzheimer's disease, which affect acetylcholine levels, memantine works by regulating the activity of a neurotransmitter called glutamate that plays a role in learning and memory. Glutamate activity is often disrupted in people with Alzheimer's disease. Because this drug works differently from cholinesterase inhibitors, combining memantine with other Alzheimer's drugs may be more effective than any single therapy. One controlled clinical trial found that people receiving donepezil plus memantine had better cognition and other functions than people receiving donepezil alone.
Doctors may also prescribe other drugs, such as anticonvulsants, sedatives, and antidepressants, to treat seizures, depression, agitation, sleep disorders, and other specific problems that can be associated with dementia.
In 2005, research showed that use of "atypical" antipsychotic drugs, such as olanzapine (Zyprexa®) and risperidone (Risperdal®), to treat behavioral problems in elderly people with dementia was associated with an elevated risk of death. Most of the deaths were caused by heart problems or infections. The FDA has issued a public health advisory to alert patients and their caregivers to this safety issue.
(Click Alzheimer's Treatment for more information about medications and other treatment options.)