It is important to work closely with a competent, experienced physician in determining the best treatment, to insure that the safest, most effective medication regime is being prescribed for your individual situation.
The most common types of progressive dementia are Alzheimer’s disease (AD), vascular dementia, dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). Although there are currently no cures for these diseases, in all cases there are medications available to help manage the symptoms of the disease and in some cases there are medications available to help slow the progression of cognitive decline.
Although no medication has been proven to stop Alzheimer’s disease, the Food and Drug Administration has approved four medications to treat AD.
Rivastigmine (Excelon®), and Galantamine (Razadyne®) are approved for mild to moderate AD.
Donepezil (Aricept®) is approved for all stages of AD.
Another medication, Memantine (Namenda®) has been approved to treat moderate to severe AD. Namenda® is also approved to be prescribed in conjunction with any of the other three drugs.
These medications may help maintain cognitive abilities and control certain behavioral symptoms helping the person function at a higher level for a longer period of time.
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There are no specific medications approved by the FDA for the treatment of vascular dementia at this time. However, if the risk factors that may have contributed to the vascular dementia, are treated and controlled, the progression of the dementia may be slowed. The major risk factors for vascular dementia are smoking, high blood pressure, high cholesterol levels and diabetes. These measures cannot restore lost cognitive function.
In addition, the medications approved to treat Alzheimer’s disease may also help people with vascular dementia. These medications include donepezil, galantamine, rivastigmine, and memantine.
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Expert physicians who treat dementia with Lewy bodies (DLB) consider the cholinesterase inhibitors - donepezil, galantamine or rivastigmine - to be the best medication options in treating the cognitive and psychiatric symptoms of DLB. In clinical studies, all were equally effective in improving cognitive, behaviorial symptoms and functional ability with typically no increase in Parkinsonism.
For Parkinson’s-like muscular symptoms, Parkinson’s disease medications can help reduce those symptoms but can also sometimes cause an increase in confusion and hallucinations.
Clonazepam and melatonin have both shown effectivness and may be recommended by your physician for treatment of the REM sleep disorder that can accompany Lewy body dementia.
It is important to note that up to 50% of all people with dementia with Lewy bodies have a dangerous sensitivity to antipsychotic medications causing severe Parkinson’s like symptoms and confusion. Antipsychotic medications are sometimes considered as a treatment for the hallucinations and delusions that can accompany this type of dementia. (Read more from the Lewy Body Dementia Association.)
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There is no cure for FTD, and in most cases its progression cannot be slowed. Although no medications have been proven effective specifically for FTD, many clinicians look to the medications and treatment approaches used in other, similar disorders to develop a therapeutic approach. For instance, some FTD patients benefit from antidepressants such as selective serotonin reuptake inhibitors (SSRIs also used in treating obsessive-compulsive disorder).
In addition, some types of antidepressants, such as trazodone, may reduce behavioral symptoms. In one controlled randomized study the cholinesterase inhibitor galantamine, significantly slowed deterioration and in some cases improved language function for people with progressive aphasia. In addition, people with progressive aphasia, may benefit from speech therapy to learn alternate communication strategies.
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