How to Slow Down Dementia: Treatment Options, Therapies, and Supportive Care

“There is currently no cure for dementia,” says Ardeshir Hashmi, MD, section chief of the Center for Geriatric Medicine at Cleveland Clinic.

But, he says, a variety of treatment options can help manage symptoms, improve quality of life, and slow the progression of disease. Read on for Hashmi’s roundup of current dementia treatment options, along with his main takeaways for caregivers.

Dementia treatment often consists of a combination of lifestyle changes, medications, therapies, and behavior and symptom management strategies.

Lifestyle changes for vascular health

Research suggests that there is a connection between the risk of developing dementia and the health of your heart and blood vessels. Taking steps to improve vascular health can lower the risk of developing dementia, and vice versa.

“What’s good for the heart is good for the mind,” Hashmi says. As such, he encourages dementia patients to adopt healthy lifestyle changes, like quitting smoking, establishing a daily exercise routine, and choosing foods from a heart-healthy diet plan like the Mediterranean diet.

Drugs for memory and cognition

Certain medications can temporarily relieve and help manage dementia symptoms related to memory and cognitive function.

• Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), attempt to slow the rate of memory decline in dementia patients. These drugs work by preventing the breakdown of acetylcholine, a chemical that helps brain cells communicate with each other. This type of medication is most often used to treat people with mild to moderate Alzheimer’s disease. Side effects of cholinesterase inhibitors include weight loss and digestive problems, such as nausea, vomiting, and diarrhea.
• Memantine (Namenda, Ebixa) helps protect against further brain cell damage in patients who have vascular dementia. This drug regulates glutamate, a chemical messenger in the brain associated with learning and memory. Dizziness is a common side effect of memantine. Memantine is approved for the treatment of moderate to severe Alzheimer’s disease.

In June 2021, the U.S. Food and Drug Administration approved a new Alzheimer’s disease drug called aducanumab (Aduhelm). Many people who have Alzheimer’s disease have amyloid plaques in the brain, and these are thought to disrupt the signals between brain cells. In several studies, people who received aducanumab experienced a reduction of amyloid beta plaques in the brain. However, approximately 40% of patients who received the highest dose of the drug experienced serious side effects like brain swelling (edema) and tiny brain bleeds (microhemorrhages). The FDA is requiring additional studies to better understand the benefits and risks, and to help identify who should receive the drug.

Regarding aducanumab, “there’s still a lot of science that needs to be done,” Hashmi says.

Treatment for dementia behaviors

Treatment for dementia behaviors — like mood changes, sleep problems, and aggression — may include a combination of approaches.

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• Behavior management strategies can help caregivers provide a more structured environment, identify and avoid triggers for problematic behaviors, and learn how to gently redirect their family member’s attention. Doctors generally prefer to try non-drug strategies for difficult dementia behaviors first, Hashmi says.
• Medications such as sleep aids, mood stabilizers, antidepressants, anti-anxiety drugs, anticonvulsants, or antipsychotics may help control symptoms in some people. However, these medications can have serious side effects, so it’s important to discuss their safety and risks with an expert, says Hashmi. “As geriatricians, we try to use these medications sparingly,” he says. “They need to be matched to the behavior. It’s not one size fits all.”

Supportive therapies for dementia

A number of rehabilitative and alternative therapies may also help manage dementia symptoms and improve quality of life.

• Cognitive rehabilitation. This type of rehab helps people in the early stages of dementia maintain memory and cognitive function for as long as possible. It also teaches compensation strategies to help people with declining cognition.
• Physical activity. Studies show that people with dementia who have a regular, light exercise routine can better perform daily tasks, and see improvements in mood and depression.
• Occupational therapy helps seniors with mild to moderate dementia by teaching coping behaviors and strategies to compensate for memory loss and cognitive decline. It can also help families make their home safer for a loved one with dementia and provide techniques to manage difficult behaviors.
• Music therapy. Listening to soothing music or singing songs can reduce agitation and aggression, according to research.
• Pet therapy may reduce anxiety, agitation, irritability, depression, and loneliness. Many memory care communities provide pet therapy or have a pet resident, often a dog or cat. Seniors in these communities can enjoy companionship without the responsibility of caring for a pet.
• Aromatherapy is safe and may relieve agitation. Lemon balm or lavender oil may be applied to the skin or sprayed in the air to create a soothing environment that promotes relaxation.
• Massage therapy. Some studies show that massage and touch therapy can help reduce agitation and encourage people with dementia to eat.
• Art therapy is believed to help slow cognitive decline and improve quality of life, but more studies are needed to confirm benefits for people with dementia.

Dietary supplements for dementia

Many dietary supplements have been studied for dementia treatment, including ginkgo biloba, vitamin B, and omega-3 fatty acids. However, results haven’t shown significant benefits. Talk to a doctor before giving your loved one with dementia any dietary supplements or herbal medicine. This will help prevent side effects and interactions with other drugs.

When it comes to dementia treatment, many factors can influence care decisions and outcomes.

Early diagnosis is key to effective treatment

Dementia symptoms are progressive, meaning they get worse over time. But an early diagnosis gives your family member a better chance of benefiting from treatment. This is why it’s important to see a doctor if you notice changes in your loved one’s behavior and memory. Understanding what’s causing your loved one’s symptoms early on can help your family member get prompt access to the right therapies and care for their condition.

Medication isn’t a cure, and it isn’t right for every situation

“Medication — actual pills or patches or any type of medication — is only 2% of what we can currently do for someone with dementia,” says Hashmi. “The 98% is actually non-medication.”

Additionally, he says, any prescriptions should be reevaluated on a regular basis. If the medicines aren’t working for your loved one or aren’t providing enough benefit to outweigh the side effects, “the endeavor is always to slowly wean off any of these medications.” Hashmi says. “The less you take, the less chance of exposure to side effects and the better people feel.”

You aren’t alone, and your needs matter too

“Other families, other caregivers are going through the same thing,” Hashmi says. He encourages caregivers to find sources of support — whether in the form of respite care or support groups — and to plan ahead. As dementia progresses, your loved one may need more care than you’re able to provide. Being proactive about understanding your local memory care options and planning for care needs protects both you and your loved one.

A Place for Mom and Cleveland Clinic: Supporting seniors and their families

This article was developed in conversation with Ardeshir Hashmi, MD, section chief of the Cleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.

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Sources

Interview conducted with Hashmi, A. Cleveland Clinic. June 28, 2021.

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U.S. Food and Drug Administration. “FDA grants accelerated approval for Alzheimer’s drug.”

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