Early, personalized care can slow down the disease.
When someone is diagnosed with dementia, help is available and treatments do exist. The exact prescription is often a combination of therapies. Experts say that starting treatments as soon as possible is crucial to slowing the advance of the disease.
Getting to the Root of the Condition
Dementia is defined as a decline in mental ability severe enough to interfere with daily life. There are many potential causes.
“Each dementia patient might have a completely different treatment plan and prognosis,” says Dr. Christian Camargo, an expert in memory, language, problem-solving and other cognitive aspects of human brain health and illness of the University of Miami Health System. “Alzheimer’s disease accounts for 60 to 70 percent of dementias, but up to 30 percent are caused by other factors.”
Root causes of non-Alzheimer’s dementias may be improper thyroid functioning, having had too many strokes, a brain tumor, or other conditions. Some are even reversible.
“We treat the cause of non-Alzheimer’s dementias,” says Dr. Camargo. “If a dementia is tied to a vascular condition, much of the treatment is focused on what led to that condition. Evidence of discreet strokes might require a therapy like aspirin, in combination with blood pressure and cholesterol-lowering medications. Some patients have a history of chronic ischemic changes in the brain — not quite strokes. In these patients, we may take a similar approach. If the patient were diabetic, we would need to address the diabetes, as well.”
Along with physical screenings and tests, cognitive test results can help identify two important conditions: a major or a minor neurocognitive disorder, says Dr. Camargo. Once doctors know which cognitive abilities are affected, and to what degree, they have a broader context of the individual’s diagnosis. A full care plan can then be created.
Dementia is a major neurocognitive disorder. This means a person’s cognitive abilities have measurably declined from normal, to the point where it interferes significantly in a person’s ability to live independently. Minor neurocognitive disorders occur when a person’s thinking skills have decreased, but the individual can still live independently.
“It is not possible to diagnose a patient with these conditions if they have delirium,” says Dr. Camargo. “In those cases, we will wait until the delirium has been treated before a dementia assessment.”
Many well-meaning care providers limit a dementia patient’s physical activities. A spouse or family member wants to keep their loved one safe. But this guarded approach may deny potential benefits to certain patients.
“In research studies, patients with dementia or mild cognitive impairment who were physically active improved their cognitive scores after six to twelve months.” says Dr. Camargo. “They decreased their risks for osteoporosis, fractures, and premature death. Feelings of depression and anxiety also went down.”
A Good Conversation … or Six
Conversations with people require input, and practice higher understanding, empathy, listening and the interpretation of facial expressions.
“Engaging in regular conversations instead of sitting at home builds up language and motor sensors in the brain,” says Dr. Camargo. “We do more harm than good for our loved ones when not increasing their social activities.”
Behavioral and Neurocognitive Treatments
Many programs are offered by comprehensive clinics, such as the University of Miami Health System Memory Disorders Clinic, where Dr. Camargo practices. The programs tap into a collaborative team of experts in psychiatry, behavioral sciences, aging, and neurology. Their programs may include:
- Internal and External Memory Strategies: Therapy sessions to help improve visual imagery association, sensory, motor and other skills.
- Cognitive-Linguistic Stimulation: Patients work at their own pace, or in group sessions, practicing real life daily activities.
- Reminiscence Therapy: This technique makes use of props, pictures, music, video, objects and games to help build memory and conversation.
- Implicit Memory Approaches: Exercises in learning and recall over progressively longer time intervals. The goal is to build techniques to help the person compensate for any loss.
- Holistic/Alternative Therapies: Sensory stimulation using toys, games, pet therapy, music and light therapy.
Alzheimer’s Disease Drug Therapy and Medications
Similar to many diseases, Alzheimer’s dementias are treated by the stage they are currently in. Each patient’s treatment plan is unique. A plan typically combines more than one approach. Currently approved medication therapies for Alzheimer’s dementias include:
- Cholinesterase Inhibitors: These drugs prevent the breakdown of acetylcholine (AChE), an enzyme in the brain. This enzyme is important to memory and learning. Studies have shown that Alzheimer’s patients have low levels of AChE. “Clinical trials showed that this family of drugs can slightly delay the progression of Alzheimer’s and may help in late stage Alzheimer’s, too. If a patient is an appropriate candidate for the drug, the earlier they start a prescription, the better,” says Dr. Camargo.
- NMDA Antagonists: NMDA is short for N-methyl-D-aspartate. NMDA helps to protect our nerve cells from getting too much calcium—which can be toxic to them, and damages the cells. This nerve cell damage has been found in Alzheimer’s patients. Memantine (Namenda XR) is a drug approved to treat patients with more advanced Alzheimer’s disease symptoms. It also has shown some benefits in patients with moderate to severe Alzheimer’s.
The Future of Dementia Treatment
Across the country and the world, scientists and doctors are aggressively in the midst of new studies. The National Institutes of Health is heavily funding new ideas, as is the pharmaceutical industry.
“Pharmaceutical companies have recently invested $1 billion in studies of Tau protein,” says Dr. Camargo. “It is the ‘other’ bad protein found in the brain tied to Alzheimer’s. Its better-known co-conspirator, Amyloid protein, has been studied exhaustively without convincing results.”
There is one proven way to best help a loved one or friend experiencing symptoms: early intervention.
“If you notice symptoms, get help from professionals as soon as possible,” says Dr. Camargo.
“It’s important to take advantage of all approaches—neurocognitive, behavioral and targeted drug approaches—when a person is diagnosed early. These can help slow down the progression of the disease. It can improve daily life for both the patient and you, the caregiver.”
Learn more about Alzheimer’s disease and dementia.
John Senall is a contributing writer for UMiami Health News.