Introduction
Only in a few cases is it possible to treat the cause of dementia. Nevertheless, the use of medication can help many patients. They are used to improve the dementia patient’s mental performance and make it easier for him or her to cope with everyday life.
Behavioural disorders can also be alleviated by medication. In some cases, drugs are used to prevent further brain damage. However, it should always be remembered that in addition to treating dementia with medication, non-drug measures are also essential.
Therapy decision
There are different forms of dementia, which require different therapies. Therefore, before dementia is treated with medication, it should be clearly diagnosed and classified. Currently, there are two groups of drugs that can improve the typical symptoms of Alzheimer’s dementia, such as disturbances in the ability to think or impairment of everyday activities.
These are acetylcholinesterase inhibitors and memantine. It is known that there is too little acetylcholine in the brain in Alzheimer’s dementia. The principle of acetylcholinesterase inhibitors is therefore to inhibit the breakdown of acetylcholine so that more of it is present in the brain.
Typical representatives of this group of drugs are donepezil, galantamine and rivastigmine. There are indications that an early start of therapy can lead to a better course of Alzheimer’s dementia; this group of drugs is recommended for mild to moderate stages. The substances are generally well tolerated, frequent side effects are the occurrence of nausea, vomiting and diarrhoea as well as headaches, dizziness and loss of appetite.
Often these occur only temporarily and can be alleviated or avoided by taking the drug with food or a creeping dosage. Since Alzheimer’s patients have an increased glutamate concentration in the brain, another possibility is to reduce the effect of the excess glutamate. Memantine, which is used for moderate to severe Alzheimer’s dementia, works according to this principle.
They also improve memory function and everyday abilities. Typical side effects are dizziness, headaches and increased drowsiness, but also blood pressure increases and constipation. However, the occurrence of these side effects can also be temporary and disappear on their own.
For severe Alzheimer’s dementia, a combination therapy of a memantine and an acetylcholinesterase inhibitor can also be considered, as there are indications that it has a better effect. Ginkgo preparations are also often used to treat Alzheimer’s dementia. As there are indications of an increased tendency to clotting due to these drugs, the blood coagulation values should be checked regularly. The study situation regarding the effect of these ginkgo preparations is not uniform. The use of other drugs such as vitamin E or non-steroidal anti-inflammatory drugs cannot be recommended at the moment, because studies have not been able to prove that these groups of substances are sufficiently effective.
