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Treatment options for dementia increase

December 26, 2005|by Dr. Matthew Wagner

Dementia, or brain failure, is a devastating disease afflicting millions of people worldwide. The most common cause of dementia is Alzheimer's disease, followed by blood vessel disease of the brain (vascular dementia). Until recently, there were few options for treatment. But that is changing.

As research expands into understanding the causes of these conditions, treatments are becoming available. Right now there is no medication or treatment which cures or reverses Alzheimer's or vascular dementia. However a group of drugs are now in use which can improve functioning and slow the rate of decline for some people, at least temporarily. They work by making the nerve cells that are still undamaged in the brain work more efficiently. These medications go by the trade names Aricept, Reminyl and Exelon. A fourth medication, Namenda, has similar benefits by a somewhat different mechanism in the brain. So it can be added to one of the other drugs to improve effectiveness.

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Research has shown that taking one of these medicines can slow the rate of decline such that nursing home placement is delayed by an average of 6 months. You will notice that this means that the disease still progresses even with this treatment. Most doctors (and families) notice only modest benefits on balance. Side effects such as muscle cramps, nightmares, nausea and diarrhea can limit their use. Another limitation is their high cost. Ongoing research holds out the hope that more effective treatments will be available, especially for Alzheimer's disease.

Although Alzheimer's disease cannot be reversed at present, many of the behavioral and psychiatric complications can be effectively treated.

Insomnia, for instance, can be a serious problem for the patient and especially for the caregiver. Caregivers quickly "burn out" if they don't get rest. There are a variety of medications that can help the patient to sleep. Often sleep will improve with simple interventions, such as limiting caffeine, discouraging naps, and increasing exercise.

Problems such as depression, paranoia, hallucinations, and agitation can be treated with medications.

Involvement in social activities or structured programs such as day care can improve the quality of life for Alzheimer's sufferers and decrease depression, agitation and social withdrawal.

Perhaps the most helpful intervention in this disease is to support caregivers and families. Alzheimer's can cause more suffering for families than for the patients, who are often unaware of their deficits. Spouses are forced to accept a change in role from partner to caregiver. The personality changes that take place can make it seem as if a stranger has come to inhabit the body of the loved one. Long-standing difficulties in relationships can become more painful as new burdens are placed on caregivers.

Support groups, counseling and respite care are often helpful in these situations. Local nursing facilities and the Alzheimer's Association offer such support groups as well as information about community resources. Respite is essential for caregivers, and can range from an afternoon out each week to short term residential placement. Counselors can help with issues of grief, anger, burn-out and family conflicts.

Of course, many families manage the challenges of Alzheimer's disease without outside help. However, if a family or caregiver is feeling overwhelmed, a little help can go a long way to re-establishing a positive framework to go forward. Many families experience a new feeling of satisfaction in being able to love and care for the Alzheimer's sufferer.




Dr. Matthew Wagner is a staff psychiatrist with Behavioral Health Services of Washington County Health System.

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