Medications, Lifestyle Changes, Supportive Care, and More -

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.

Drugs aren’t the only way to address noncognitive dementia symptoms. Changes to the home environment can encourage calm and peace of mind, and both behavioral and scheduling changes may help reduce sleep disruption.

Treatments for Underlying Issues

Certain health problems can contribute to cognitive decline, especially when it comes to cardiovascular issues and vascular dementia.

Your doctor may prescribe treatments for the following conditions:

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.

Nondrug approaches to mood and behavior issues may include the following:

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

The following types of drugs may be prescribed to help with mood or behavior changes in people with dementia:

Antidepressants to treat depression or irritability
Anxiolytics (antianxiety drugs) for anxiety, restlessness, or disruptive behavior
Antipsychotic medications for hallucinations, delusions, agitation, or aggressive behavior

Antipsychotic medications are linked to an increased risk of stroke and death in older adults with dementia and should be prescribed with extreme caution.

Traditional antipsychotic medications can be dangerous for people with Lewy body dementia, potentially causing severe confusion, extreme abnormal movements, sedation, or even death. Doctors may prescribe so-called atypical antipsychotic drugs at low doses for a limited time.

For people with frontotemporal dementia, both antidepressants and antipsychotic drugs can help with behavioral symptoms. But as in all cases, antipsychotic drugs should be used with extreme caution due to the increased risk of death.

Treatments for Sleep Problems

Dementia can cause difficulty falling or staying asleep (insomnia) as well as other changes, such as greater daytime sleepiness. Certain lifestyle and environmental changes may help with sleep:

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

One drug, suvorexant (Belsomra), has been approved to treat insomnia in people with Alzheimer’s disease. But other drugs may be used for sleep issues in people with dementia:

Tricyclic antidepressants
Benzodiazepines and other sedatives
Antipsychotic medications

One common symptom of Lewy body dementia is REM sleep behavior disorder, in which people physically act out their dreams. Clonazepam (Klonopin), a drug used for seizures and panic attacks, can reduce this symptom. The sleep hormone melatonin may also help on its own or in combination with clonazepam.

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.

Exercise and physical therapy may also help with movement symptoms in Lewy body dementia.

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