What is the role of the physician in treating dementia?

Patients or families who believe that the normal effects of aging have been exceeded should consult a physician, often a family practitioner, internist, geriatrician, or neurologist. The evaluation that can be expected should include a careful and thorough history and examination with neurological assessment, involving some screening tests of cognitive function designed to aid in diagnosing impairment in cognition.

Additional laboratory studies would usually involve blood work and a scan of the brain to look for conditions other than the most common form of dementia, Alzheimer's disease.

What can be done about Alzheimer's disease?

At this point Alzheimer's disease cannot be cured. However, it can be effectively managed through education on the disease and on handling behavior, as well as counseling and support for family members and caregivers. Some medications are available to treat the changes that occur with the disease.

Medications for Alzheimer’s

Current symptomatic drug treatment targets the cognitive and the behavioral changes brought about by this disease. Four drugs are currently available for cognitive impairment: donepezil (Aricept®), rivastigmine (Exelon®), galantamine (Reminyl®), and memantine (Namenda®).

The first three medications increase the neurotransmitter acetylcholine, which is deficient in patients with Alzheimer's disease. Side effects are common, including decreased appetite, weight loss, diarrhea, and even slow heart rate and increased risk of passing out. Memantine acts on a different chemical system, and is commonly used together with one of the other medications and also to help with disease symptoms, including irritability and agitation.

Non-medication approaches to Alzheimer’s

Of equal or perhaps even greater importance are efforts to control the behavioral aspects of dementia, including apathy, agitation, anxiety or irritability, wandering, depression, and lack of inhibition.

A variety of non-medication approaches are available. The most important of these include:

  • Educating the caregiver about the disease
  • Providing the patient with a stable and calm environment
  • Offering the patient outlets for energy expression
  • Promoting normal sleep patterns

Medications may be necessary for sleep and for the not uncommon symptoms of uncontrollable agitation, violence, or hallucinations.

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