For many people with dementia, cognitive issues aren’t the only target of treatment. “You’re not just talking about cognition. You’re talking about behavior,” says Segal-Gidan. “Most of the drugs that we use are addressing these symptoms, whether that’s depression or anxiety or psychosis.”
In early stages of Alzheimer’s disease, irritability, anxiety, or depression are common. In later stages of the disease, many people also experience aggression, agitation, hallucinations, or sleep disruption.
Treatments for Underlying Issues
- Hearing Loss Hearing loss can make it more difficult to interact with others and may increase the risk for cognitive decline.
- High Blood Pressure High blood pressure is linked to vascular dementia, as well as stroke and other forms of cardiovascular disease linked to cognitive decline.
- High Blood Sugar Elevated levels of blood sugar (glucose) in people with diabetes are linked to a greater dementia risk.
- High Cholesterol Abnormal cholesterol or triglyceride levels can contribute to vascular dementia.
- Blood Clot Risk If you’re at risk for a blood clot that could cause a stroke or heart attack, you may take medications to reduce this risk.
Treatments for Mood and Behavior
While mood and behavior changes are common in dementia, it’s important for any prescription drugs addressing them to be carefully considered — and to look at other ways to help reduce distress and otherwise improve the person’s life.
“Even with drugs, nonpharmacological approaches can be very effective” for mood and behavioral issues, says Segal-Gidan.
- Reducing physical obstacles or clutter in the home
- Creating a calm environment without excess noise, glare, or distractions like a television in the background
- Scheduling periods of rest between stimulating events
- Providing a security object like a stuffed animal or blanket
- Checking for issues like pain, hunger, thirst, constipation, a full bladder, or skin irritation
- Remaining flexible and nonconfrontational in interactions with the person
- Antidepressants to treat depression or irritability
- Anxiolytics (antianxiety drugs) for anxiety, restlessness, or disruptive behavior
- Antipsychotic medications for hallucinations, delusions, agitation, or aggressive behavior
Treatments for Sleep Problems
- Maintaining a regular sleep and mealtime schedule
- Getting morning sunlight exposure
- Exercising daily, but not within four hours before bed
- Avoiding alcohol, caffeine, and nicotine
- Maintaining a comfortable bedroom temperature
- Using your bed only for sleep (not for television or reading)
- Having night-lights to feel safe while in bed
- Tricyclic antidepressants
- Benzodiazepines and other sedatives
- Antipsychotic medications
Treatments for Movement Issues in Lewy Body Dementia
People with Lewy body dementia usually develop movement symptoms such as muscle rigidity, a shuffling walk, and loss of muscle coordination. These symptoms may not occur until several years after cognitive symptoms begin.
A medication combining carbidopa and levodopa (Sinemet) can help people who have Lewy body dementia with walking and movements like getting out of bed. But it can cause hallucinations and other psychiatric problems, so it’s typically not used to treat mild symptoms.
