Prolong independency

Dementia is a syndrome that affects daily living function and as you get older, the risk of developing dementia increases.

As mentioned in my previous articles, there are multiple types of dementia and dependent on the type, there are subtle differences in treatment.

The main aim of using medicines is to prolong independency as long as possible and prevent complications associated with it. In this article I will highlight some of the medicines used, including information about their side effects.

Treatment of dementia is dependent on the cause and whether it is reversible or irreversible.

If reversible, the cause is usually treated, like antidepressants for depression and vitamin B12 replacement for vitamin B12 deficiency. For the irreversible types including Alzheimer’s, vascular and Lewy-body dementia there are four common medications used: Donepezil (Aricept), Rivastigimine (Exelon), Memantine (Ebixa) and Galantamine (Reminyl).

Those medications work by adjusting the chemical imbalance in the brain which will in turn help stabilise and improve the symptoms.

You should start at lower doses and increase the dose as tolerated. Also, keep in mind that most side-effects are transient, especially the stomach upset which usually goes away after a few weeks.

Your doctor will assess your symptoms after four-six months of treatment, with the help of what your loved ones have noticed, and adjust the dose, or change the medication. Let’s go through each of those medications separately.

• Denepezil (Aricept): It belongs to the group of acetylcholinesterase inhibitors. It is usually used for mild forms of dementia. The side effects include nausea, vomiting, insomnia, muscle cramps and tiredness. On rare occasions it can cause fainting attacks and you should contact your doctor straight away if those develop.
• Rivastigimine (Exelon): Similar to donepezil, it is used in more severe forms of dementia, The stomach-related side-effects can be avoided with Rivastigmine as it is available in a skin patch form instead of oral tablets. It is also preferred in patients with Parkinson’s disease and dementia. It has a similar side-effect profile as Donepezil. 
• Galantamine (Reminyl): Used for more severe forms of dementia, the side-effect profile is similar as above.
• Memantine (Ebixa): It is different than the previous three drugs as it works on a chemical in the brain called glutamate. It is used in moderate forms of dementia and can be used if the patient is intolerant to the above three drugs, although side-effects include agitation, depression, tiredness, incontinence and dizziness.

It is very important to report any side-effects to your doctor.
The effectiveness of these medications still needs further research; however, it is known that about half the people treated with cholinesterase inhibitors will see an improvement in symptoms that affect thinking and memory. Some of those medications may also slow down the progression of dementia.

For the psychotic symptoms such as hallucinations, agitation and insomnia, antipsychotics like haloperidol or quetiapine can be prescribed.

All the medications mentioned above are prescription-only. If your loved one is suffering from memory loss and or the other symptoms of dementia and was diagnosed with it, speak to your doctor about treatment methods and which one is most suitable.