Drugs for vascular dementia
Vascular dementia is a generic term for dementias that occur due to damage to the brain vessels. Therefore, the basis of therapy for this form of dementia is to prevent further vascular damage. This requires the adequate treatment of high blood pressure, sufficient exercise, giving up nicotine consumption and, if necessary, weight reduction. Possible drugs for the treatment of vascular dementia are, as in Alzheimer’s dementia, acetylcholinesterase inhibitors and Memantine. In vascular dementia, these drugs also improve memory and thinking skills, although they are less effective than in Alzheimer’s dementia.
Frontotemporal dementia
There are currently no uniform standards for the treatment of frontotemporal dementia. Although there are studies on drugs called galantamine, trazodone and paroxetine, these were conducted with too few patients to be able to apply the statements made to all those affected.
Lewy-Body dementia
For Lewy Body Dementia, too, there is no sufficiently proven and thus generally recommended drug therapy. However, there are indications for the efficacy of the acetylcholinesterase inhibitor rivastigmine, which seems to have a primary effect on the behavioural symptoms of the patients. It should be noted, however, that this drug therapy can lead to a deterioration in motor function.
Dementia in Parkinson’s disease
Parkinson’s disease is also often accompanied by dementia. In the mild to moderate stages, patients can be treated with the acetylcholinesterase inhibitor rivastigmine. Rivastigmine can improve the disorders of memory and thinking as well as everyday functions. However, it should also be noted that rivastigmine can lead to a worsening of motor symptoms of Parkinson’s disease.
Drug therapy of other dementia symptoms
In addition to disturbances of consciousness and perception, people suffering from dementia often also experience behavioural changes. It is always important to question whether there is a cause for the respective change in behaviour. For example, pain or a changed environment can also lead to a change in behaviour in dementia patients.
If there is no specific cause or if it is not possible to eliminate it, it may be necessary to use the neuroleptic drug group. If depressive moods occur in dementia patients, they should be treated with antidepressants. Because of their side effects, the tricyclic antidepressants are not recommended.
It is not uncommon for people with dementia to exhibit increasingly aggressive and agitated behaviour, i.e. increased tension. This places a massive burden on the carers in particular. Presumably, this occurs mainly out of fear or when the dementia sufferer has the feeling that he or she can no longer make himself or herself understood.
Often a change in the environment or communication already leads to an improvement of the situation. Only as a last resort should a drug therapy be used, the neuroleptic Risperidone is especially recommended here. The occurrence of delusions and hallucinations is also common in dementia.
However, these symptoms can also always be a side effect of medication or occur, for example, in the context of delirium. Therefore, these causes should always be excluded before starting medication. Risperidone is also the drug of choice for delusions and hallucinations.
Disorders of the day-night rhythm and disturbed night sleep also often occur in dementia patients and can put a heavy strain on the environment. However, sleeping pills should be used rarely and only with extreme caution. In dementia patients, they can lead to a deterioration of consciousness and memory and are associated with an increased risk of falling.
