Treatment -Alzheimer’s disease
There is no cure for Alzheimer’s disease yet, but there are medications that can help lessen the symptoms for a while. Additionally, support is available to assist both individuals with the condition and their families in handling daily life.
The main medicines prescribed for Alzheimer’s disease include cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine, which aim to enhance communication between nerve cells by increasing levels of acetylcholine. Another option is memantine, which works by regulating glutamate activity to help improve memory and cognitive functions. These medications may provide temporary relief from symptoms, but they do not stop the progression of the disease.
Acetylcholinesterase (AChE) inhibitors, such as donepezil, galantamine, and rivastigmine, increase acetylcholine levels in the brain to enhance communication between nerve cells, and they are typically prescribed by specialists like psychiatrists or neurologists, although GPs with specific expertise may also prescribe them. These medications are primarily intended for individuals with early to mid-stage Alzheimer’s disease, with rivastigmine also available in patch form. Recent guidelines suggest that these medications can be continued into the later, severe stages of the disease. While the effectiveness of all three AChE inhibitors is comparable, individual responses and side effects, such as nausea, vomiting, and loss of appetite, may vary, typically improving after two weeks of use.
Medicines to treat challenging behaviour
In the later stages of dementia, many individuals may experience behavioral and psychological symptoms of dementia (BPSD), which can include agitation, anxiety, wandering, aggression, and delusions or hallucinations. These symptoms can be distressing for both the affected individuals and their caregivers. If non-pharmacological coping strategies are ineffective, a consultant psychiatrist may prescribe antipsychotic medications like risperidone or haloperidol for individuals displaying persistent aggression or extreme distress, as these are the only drugs licensed for moderate to severe Alzheimer’s disease with a risk of harm. Risperidone should be administered at the lowest effective dose and for the shortest duration due to potential serious side effects, while haloperidol should only be considered when other treatments have failed. Antidepressants may also be considered if depression is suspected to contribute to anxiety. Additionally, other medications may be prescribed off-label to address specific BPSD symptoms, but the prescribing physician must justify their use in these cases.
Treatments that involve therapies and activities
Medicines for Alzheimer’s disease symptoms are only one part of the care for the person with dementia.
Other treatments, activities and support – for the carer, too – are just as important in helping people live well with dementia.
Cognitive stimulation therapy
Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve memory and problem-solving skills.
Cognitive rehabilitation
This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks.
Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not.
Reminiscence and life story work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows they can improve mood and wellbeing.
