drugs A Review of Dementia Drug Therapy Dementia Drugs: What are the different types of drugs used for managing dementia, what effect do they have, and which ones really work. December 16, 2015 Written By: Andy Laz
drugs A Review of Dementia Drug Therapy Dementia Drugs: What are the different types of drugs used for managing dementia, what effect do they have, and which ones really work. December 16, 2015 Written By: Andy Lazris, M.D. Published On December 16, 2015 Dementia is one of the most frightening diseases that inflicts my patients. Approximately 2 million Americans suffer from dementia, and that number is increasing as more people are aging. Dementia is not merely memory loss; in fact, most elderly people suffer from memory loss as they age, and few of them actually become demented.Dementia Is Not Just Memory LossRather, dementia is deterioration of the thought process. While people with memory loss may forget someone's name or not remember where they put their keys, people with dementia cannot follow a conversation and often become confused about simple tasks. Most dementia also progresses through seven stages; the symptoms worsen with time at variable rates, and can often lead to total disability and dependency. While many forms of dementia exist, from Alzheimer's Disease to Pick's Disease, the deterioration in thinking and reasoning is similar in all of them.What causes dementia? Put simply, we do not know. We do know that something (we think it is an abnormality of a certain protein in the brain) triggers a cascade of brain cell destruction that we have no capacity to prevent or stop. Very little of dementia is genetic; most cases occur in people who have no family history of the disease. The primary locations of brain cell destruction define what type of dementia, and consequently what symptoms, patients have. Some people with the disease hallucinate, some become agitated and violent, some become more passive and lethargic; there are probably many more forms of dementia than medical science has described, and most people have a combination of symptoms that change over time. Many dementia patients remain physically strong and live a long life, others stop eating or are prone to illness due to disability. In all cases, we can treat the symptoms, but not the disease. There are drugs being tested that may impact disease progression by altering the protein malfunction, but these are in very preliminary trials. There are also several conditions that mimic dementia and can potentially be treated, but these are rare; of 1000 people who are screened for a reversible cause of dementia, only 3 are found to have reversible disease, and most of those are discovered by a basic set of tests that can be done by a primary care doctor. Seeing neurologists and doctors who are memory experts has not been shown to provide any benefit to dementia patients.There Is No Cure; Just MitigationIt is very important to realize that we currently have no treatment for dementia. While a host of medicines are offered to dementia patients, none of them alter the course of the disease. At best they can mitigate symptoms for a very brief period of time before they become ineffective. Still, that does not stop doctors and pharmaceutical companies from pushing these drugs, both individually and in combination, as a potent treatment for dementia. Unfortunately, as many of these drugs have side effects and interactions, and many of the newer ones are very expensive, their wide spread use has not made a significant dent in the lives of demented patients while often leading to untoward effects and escalating cost. The reliance on such drugs has also moved resources and focus away from more reliable ways to help control dementia, such as exercise, diet, and daycare programs.Primary Dementia Drug TypesThere are two primary types of dementia drugs. One has been around for several decades and has been well studied—the cholinesterase inhibitors (CI's)—which work by altering a brain chemical that may improve mental function temporarily. Most studies on these drugs have been done on Aricept (donepezil), one of the 