How is dementia treated? Drugs and non-pharmacological treatment

Pharmacological treatment of dementia can be divided into primary and secondary therapy.

• Primary therapy includes so-called cognitive agents. Drugs in this group are intended for the symptomatic treatment of cognitive deficits in dementia. Their effect is to slow the progression of the disease. This includes agents such as cholinesterase inhibitors, NMDA receptor antagonists, memantine and ginkgo biloba extract.
• Secondary treatment consists of the use of drugs to help manage the neuropsychiatric symptoms of dementia, such as depression.

Primary therapy

The largest group are cholinesterase inhibitors, which slow the progression of clinical symptoms of dementia. They have become frequently used and relatively successful drugs. The principle of action is to inhibit the enzymes that break down acetylcholine.

In order to have the greatest benefit, these drugs should be introduced at the onset of the disease, in the early stages of dementia. When they have a positive effect, patients describe an improvement in cognitive function and maintenance of the pace of daily functioning.

The three cholinesterase inhibitors often used are donepezil, rivastigmine and galantamine.

Common side effects include:

• bradycardia
• increased gastric acid secretion
• increased irritability of the gastrointestinal tract
• Nausea
• diarrhoea
• anorexia (lack of appetite)

The second drug of choice is an NMDA receptor inhibitor. The treatment is based on the hypothesis that the cognitive impairment is also due to NMDA glutamatergic hyperactivity.

The mechanism of action is to prevent the release of glutamate. Glutamate is a so-called excitatory neuronal transmitter, a chemical substance that mediates the transmission of impulses between nerve cells and is excitatory in nature.

The effect of memantine results in improved cognitive impairment, particularly improved memory, but also slows the loss of nerve cells and therefore the progression of dementia.

Memantine is relatively well tolerated by patients. It has only minimal side effects:

• dizziness
• headache
• constipation
• drowsiness

Ginkgo biloba extract is an aid in the treatment of many types of dementia, e.g. Alzheimer's disease or vascular dementia. It is used in the early stages of dementia with a mild course.

It improves the blood supply to the brain tissue, its oxygenation, has a neuroprotective effect, scavenges free radicals, and thus has an antioxidant effect.

The herb is non-toxic and very well tolerated in reasonable amounts. Slight side effects include possible antiplatelet action, i.e. increased risk of bleeding.

Secondary therapy

This is a drug-induced promotion of neuropsychiatric fitness. Commonly used are antidepressants and antipsychotics.

Non-pharmacological treatment of dementia

Non-pharmacological treatment consists of regular 'training' of the brain. By this we mean active maintenance of cognitive function. Various exercises are available, whether pictorial or numerical, fun tasks, puzzles and so on.

Other ways to improve the patient's condition are:

• aromatherapy
• music therapy
• pet therapy
• educating caregivers on proper care
• psychological support for family members