Dementia

Alternative Names

Treatment

The goal of treatment is to control the symptoms of dementia. Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.

Stopping or changing medications that make confusion worse may improve brain function. Medicines that contribute to confusion include:

• Anticholinergics
• Central nervous system depressants
• Cimetidine
• Lidocaine
• Painkillers (analgesics)

Treating conditions that can lead to confusion can often greatly improve mental functioning. Such conditions include:

• Anemia
• Decreased oxygen (hypoxia)
• Depression
• Heart failure
• Infections
• Nutritional disorders
• Thyroid disorders

Medications may be needed to control behavior problems. Possible medications include:

• Antipsychotics
• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) for Alzheimer's-type dementia
• Dopamine blockers (haloperidol, risperdal, olanzapine, clozapine)
• Mood stabilizers (fluoxetine, imipramine, citalopram)
• Serotonin-affecting drugs (trazodone, buspirone)
• Stimulants (methylphenidate)

A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.

Psychotherapy or group therapy usually does not help because it may cause more confusion.

LONG-TERM TREATMENT:

A person with dementia may need monitoring and help at home or in an institution. Possible options include:

• Adult day care
• Boarding homes
• Convalescent homes
• In-home care

Family members can get help caring for the person with dementia from:

• Adult protective services
• Community resources
• Homemakers
• Visiting nurses or aides
• Volunteer services

In some communities, support groups may be available (see elder care - support group). Family counseling can help family members cope with home care.

Other tips for reducing disorientation:

• Have familiar objects and people around
• Keep lights on at night
• Provide environmental and other cues with reality orientation
• Reward appropriate behaviors and ignore inappropriate ones to control unacceptable or dangerous behaviors
• Stick to a simple activity schedule

Advance directives, power of attorney, and other legal actions may make it easier to decide about the care of the person with dementia. Seek legal advice early in the course of the disorder, before the person with dementia is unable to make such decisions.

Outlook (Prognosis)

Dementia usually gets worse and often decreases quality of life and lifespan.

Possible Complications

Complications depend on the cause of the dementia, but may include the following:

• Abuse by an overstressed caregiver
• Increased infections anywhere in the body
• Loss of ability to function or care for self
• Loss of ability to interact
• Reduced life span
• Side effects of medications used to treat the disorder

When to Contact a Medical Professional

• Call your health care provider if dementia develops or a sudden change in mental status occurs.
• Call your health care provider if the condition of a person with dementia gets worse.
• Call your health care provider if you are unable to care for a person with dementia at home.

References

Alva G. Alzheimer disease and other dementias. Clin Geriatr Med. 2003; 19(4): 763-76.

American Academy of Neurology. About Dementia. Neurology. 2004; 63(10); E20.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:283-286.

Goetz, CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders; 2007.

Farlow MR, Cummings JL. Effective pharmacologic management of Alzheimer's disease. Am J Med, 2007;120:388-397.