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Lori Besl

Prof. Johnson

ENG 1201.506

18 July 2021

Best Available Dementia Treatments

After watching two grandparents fall victim to the terrifying grasps of dementia

caused by two completely different diseases, I began to wonder what was available to

help the patient and their caregivers. What treatments are available for dementia, and

which one is best? After digging deep into dementia treatments, it has become apparent

that dementia patients have a myriad of treatment options now available to them. By

taking a pharmaceutical and therapeutic combined approach, dementia patients and

their caregivers will see the best cognition and life expectancy results.

Alzheimer’s is the most well-known and prevalent type of dementia; the second

is Vascular Dementia (strokes and blood clots), and then Frontotemporal and Lewy

Body dementias. Other diseases that may lead to dementia are traumatic

encephalopathy, Pick’s Disease, and Parkinson’s Disease (Goodman 1). The fifth

leading cause of death globally is dementia, with Alzheimer’s accounting for 60-70% of

cases (Kruger et al. 1). Studies show that aside from early detection, maintaining

cognitive function is the main priority for dementia patients, their doctors, and caregivers

(Maki et al. 11).

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Pharmaceutical treatments available include nootropic drugs which are

stimulants such as Adderall and caffeine. Cholinesterase inhibitors are a type of

nootropic drug that can treat various stages of cognitive disfunction and support

communication between nerve cells in the brain, the most common is Donepezil.

Glutamate regulators, such as Memantine, help the brain process information

(Alzheimer's Association 3). Cholinesterase inhibitors work by supporting the levels of

chemical messengers in the brain, used in memory and judgment (Mayo 2). These

cholinesterase inhibitors are usually prescribed to Alzheimer's patients but can also help

treat patients suffering from other types of dementia and can be prescribed in

combination with glutamate regulators (Mayo 2). However, these drugs don't come

without side effects, including nausea, vomiting, diarrhea, sleep disturbances, slowed

heart rate, and fainting (Mayo 2).

Anti-dementia drugs are also available, but there is only one that the FDA has

approved; Aducanumab, which benefits cognition and function in Alzheimer’s patients

and may delay the patient’s clinical decline. However, the FDA has specified that this

medication is only approved for early-stage dementia patients (Alzheimer’s Association

1). The side effects for Aducanumab include amyloid-related imaging abnormalities

(ARIA), headaches, and falls. ARIA is a temporary swelling in areas of the brain, doesn't

always cause symptoms, and can resolve on its own over time (Alzheimer's Association

2).

Studies are still being performed to determine if other medications are

appropriate for the treatment of dementia. One study is investigating the validity of a

class of antibiotics called aminoglycosides to treat frontotemporal dementia. Some

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patients with frontotemporal dementia (FD) have a specific genetic mutation that blocks

the brain’s production of a protein called progranulin; the absence of this protein is

linked to FD (Mental Health Weekly 1). Studies show that using these antibiotics on

cells affected by this mutation causes the cells to ignore the mutation and produce the

progranulin protein. This study shows the progranulin levels in these cells were

recovered up to 50-60 percent (Mental Health Weekly 1). Probiotics are also being

studied for cognitive support of persons with dementia. So far, these studies have failed

to find results to support this theory; however, they did see positive results for other

ailments. These probiotics improve a patients' plasma triglycerides, insulin resistance,

plasma malondialdehyde, and one type of cholesterol (Kruger et al. 166).

A study conducted in Japan from 2000-2010 has proven the effectiveness of

these nootropic and anti-dementia drugs; this study confirmed that consistent anti-

dementia and nootropic drug treatments are shown to slow the decline of cognitive

function and improve daily function (Wu et al. 2). Furthermore, when Chen-Yi Wu et al.

researched the mortality of people with dementia concerning pharmaceuticals, they

discovered that anti-dementia and nootropic drugs could significantly increase life

expectancy after diagnosis compared to no medication (5,6). See Figure 1 on the next

page.
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Life Expectancy of Dementia Patients Based on Medications Prescribed

10 9.03
8.11
8 6.62
6
6
Years

4 3.39 3.01
2
0 0
0
Vascular Demntia Degenerative Dementia
Type of Dementia

Without Medication With Nootropics With Anit-Dementia Meds Combined Meds

Figure 1: Shows the life expectancy of dementia patients who receive pharmaceutical treatments vs. no

pharmaceutical therapies. Note: anti-dementia drugs are not approved for vascular dementia, hence the lack of

results for anti-dementia and combined medications in that category.

Other therapies studied for the treatment of dementia include occupational

therapy, modifying one's environment, cognitive stimulation therapy, and dance

movement therapy. Occupational therapy is the most common non-pharmaceutical

treatment and is generally one of the first steps for patients with a dementia diagnosis.

This type of therapy teaches the caregivers steps to make the home a place the patient

will be safe in and teach the patient valuable coping mechanisms. This therapy will

hopefully reduce at-home falls, mitigate confusion, manage one's behavior, and help the

patient/family prepare for the progression of dementia (Mayo 2,3).

Cognitive stimulation therapy (CST) is a non-pharmaceutical treatment option

with a positive evidence base showing it can improve quality of life and cognition for

dementia patients (Holden et al. 1554). A study was conducted by the NHS (National

Health Service) in Great Britain from 2014-2018 to determine the efficacy of widespread

CST. The study shows that while CST is proven to improve the lives of dementia
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patients, modifications implemented by the individual providers have reduced the

efficacy of CST. When CST is delivered following the evidence base, it provides 14

sessions two times a week for seven weeks. The report said these sessions should be

based on cognitive stimulation, instigating new ideas, and respect, with less focus on

facts and more on opinions, and person-centeredness while maximizing the potential of

the dementia patients (Holden et al. 1554). Unfortunately, not all CST providers follow

these evidence-based guidelines, thus affecting the results seen in patients. However, if

a standardized method is implemented across Great Britain, studies prove this to be an

effective therapy to increase the quality of life and cognitive function for dementia

patients (Holden et al.1561).

Dance movement therapy is proven to be an effective non-pharmaceutical

treatment for dementia with encouraging results. A study was performed to determine

how dance movement therapy affects a dementia patient’s mood and cognitive function.

Before the study, patients were asked their thoughts on different ideas used to assess

depression. Patients reported a lack of interest in any activity, having undesirable

relationships with friends and family, and feeling lonely, sad, bored, useless, scared,

and lacking a desire to live. There were also reports of hopelessness and loss of energy

(Simona et al. 93). All of the patients interviewed before the therapy reported being

unhappy with their overall quality of life and health. After the six-month study of weekly

dance movement therapy, results prove an increase in the quality of life and

improvement in dementia patient's mood and their caregivers (Simona et al. 94).

Patients reported having increased interest in activities, improved relationships with

friends and family, and decreased feelings of loneliness and sadness, with an added
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increase in self-confidence (Simona et al. 94). In the end, all patients were reported to

be more satisfied with their quality of life and an increased interest in everyday activities

and relationships. Thus, increasing one’s lifespan (Simona et al. 94).

One study conducted in the UK was meant to determine the effects of continued

occupational therapy on dementia patients and their caregivers vs. the effects of

treatment as usual (TAU), which consists of limited occupational therapy sessions. The

study was a single-blind, randomized controlled trial and studied 130 patient and

caregiver pairs and proved inconsequential. Alternatively, the same analysis performed

in the Netherlands proved to be very successful. The discrepancies are likely due to the

differences in the TAU offered by the countries (Wenborn et al. 2). The community

therapy in the Netherlands consisted of ten sessions carried out over a five-week period

in the patients' homes. This therapy proved to be effective in increasing benefits to the

patients’ mood, quality of life, and daily activities with better competency and improved

attitudes in caregivers (Wenborn et al. 9). When the study was conducted, the

Netherlands had very minimal TAU offered, which may be why they saw such improved

results.

Currently, there are no proven methods to prevent dementia. However, Ira

Goodman MD interviewed Dr. Dale Bredesen of UCLA about his new non-

pharmaceutical approach to dementia treatment and prevention (2). Dr. Bredesen’s

approach is referred to as functional medicine with some twists and consists of

extensive research into the patient’s medical presentation and many personalized

treatments (Goodman 2). Dr. Bredesen’s studies have shown drastic improvement for

some of his patient’s cognitive function and quality of life. People don’t realize that many
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factors can contribute to the development of dementia including, trauma, prescription

medications, trans fats, heavy metals, and some organic compounds that can cause

dementia (Goodman 2). The treatments in Dr. Bredesen's plan consist of genetic

testing, toxic burden assessment and correction, special diets, a personalized exercise

plan, varied brain training, lifestyle analysis, modification of nutrient and sleep

deficiencies, and comorbidity treatment. This long list of tests and treatments leads this

to be a somewhat invasive and expensive treatment option while proving to be quite

effective. For example, the most successful patient Dr. Bredesen treated, initially tested

in the seventeenth percentile for hippocampus brain function before the treatments were

implemented. However, after less than one year of treatment by this comprehensive

treatment plan, the same patient tested in the seventy-fifth percentile for hippocampus

function, and the clinical findings also completely reversed (Goodman 2).

Severe deficits in knowledge about dementia circulate throughout the human

population. Studies conducted in the US, across Europe, Asia, and Australia

demonstrate that close to fifty percent of the people questioned are under the

impression that dementia is an unavoidable, regular part of aging (Cations et al. 5). The

knowledge of potential prevention and treatment of dementia among people is deficient.

Still, it also showed that people are learning about dementia and that the overall

knowledge surrounding the disease is improving (Cations et al. 1). New accumulating

evidence indicates that managing certain risk factors can potentially prevent one-third of

dementia cases. The WHO (World Health Organization) has implemented a “Global

Action Plan on Dementia” and is urging every country to begin awareness campaigns

for dementia to educate the public on the disease, prevention, and treatment by the
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year 2025 (Cations et al. 2). Knowledge about potential treatment and prevention can

promote optimism among the population, increase early diagnosis, and curb

undesirable health behaviors in early and mid-life (Cations et al. 2). The belief that

dementia is an unavoidable effect of aging hinders the search for preventative health

behaviors and help-seeking diagnoses because patients believe nothing can be done.

This attitude changes among the population as awareness about dementia, its causes,

and treatments become more widespread (Cations et al. 7).

The perspectives and expectations of dementia treatments can vary significantly

between the patient, the doctor, and the caregiver. A study conducted in Japan asked

163 doctors, 27 patients, and 24 caregivers what the top priorities of treatment are for

them. The top priority for doctors and caregivers is maintaining cognitive function, while

the top priority for the patient is maintaining a good quality of life. The dementia patient

also felt that reducing their family burden was also a top priority (Maki et al. 9). Figure 2.
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Top Priorities
50
45 43.6

40 37.5 37
35
29.2
30
25.9
25 22.2 23.3
20 16.7
15 11.7 12.5
10.4
10 7.4
4.3 3.7
5 2.5
0 0 0
0
Cognitive Function Mitigating Maintaining QOL Mental Support Socialization Maintaining
SymptomsDementia Patient Family/Caregivers Doctors Activities of Daily
Living
Fi

gure 2: Shows top priorities for treatment outcome according to the physician, the patient, and the

families/caregivers.

The lowest priorities for these same groups of people vary widely as well. For the

patient, the last priority is maintaining activities of daily living. The lowest preference for

families and doctors alike is maintaining the quality of life for the patient. Dementia

patients also see the value in reducing their family care burden, whereas the families

didn't feel the same (Maki et al. 10).

Families and caregivers can also participate in the treatment of dementia patients

by practicing some supportive and therapeutic habits. Caregivers should use enhanced

communication by maintaining eye contact and speaking slowly and clearly with one

topic at a time. Encouraging exercise and activity levels can significantly impact the

patient's quality of life (Mayo 3). Caregivers are also encouraged to assist the patient

with establishing nighttime rituals and updating calendars while helping them plan for

their future. Dementia patients are prompted to take care of themselves to develop good

coping techniques for dealing with a dementia diagnosis. Learning about the disease,
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joining local support groups, keeping a journal, and talking to a therapist are all

encouraged practices to help a patient cope (Mayo 4). Caregivers and family members

are instructed to interact with the dementia patient in supportive and reassuring ways,

such as listening to the patient and reassuring them that they can still enjoy life. Being

positive and helping the patient maintain self-respect and dignity are all great

techniques (Mayo 4).

Some studies have failed to prove the effectiveness of some of the treatment

options available, such as Wenborn et al.’s study in the UK with continued occupational

therapy vs. traditional occupational therapy. Even though previous studies proved it

effective, too many variables were present to determine a definitively positive outcome.

More studies could help cut down on variables and assess the effectiveness of

continued occupational therapy. Studies for new pharmaceutical approaches to

dementia treatment are also providing no positive results; antibiotics that show promise

on the molecular level fail when applied to an actual patient (Mental Health Weekly 1).

And probiotics can offer some positive effects for other ailments, but not dementia

(Kruger et al. 166).

It is widely believed that dementia is unavoidable and untreatable, leading many

naysayers to disagree with the treatment options available (Cations et al. 5). Adverse

side effects for pharmaceutical treatments are also a downfall to the available

treatments. For example, Aducanumab has side effects such as ARIA, headaches, and

falls, which can be detrimental to an aging person. Other medications prescribed for the

treatment of dementia have side effects such as vomiting, nausea, muscle cramps, loss

of appetite, more frequent bowel movements, headache, dizziness, and possibly

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confusion (Alzheimer's Association 2,3,4). These undesirable effects can deter people

from seeking treatments that could help them improve their quality of life and cognitive

function.

Very few studies have been conducted to test the combined effects of

pharmaceutical and therapeutic treatments for dementia patients. The treatment studies

are individually promising, and one could therefore conclude that pharmaceutical and

therapeutic treatments combined will produce the most favorable results in cognitive

function, quality of life, and longevity. For example, dance movement therapy combined

with nootropic drugs could have improved my grandmother's quality of life after having

the several strokes that lead to her dementia. My grandfather's Parkinson's induced

dementia could have been treated with cholinesterase inhibitors which have been

approved to treat Parkinson's and dementia-related symptoms. General education on

dementia itself, anti-dementia medications, and nootropics in addition to dance

movement and occupational therapies, could have significantly improved both of their

lives and countless other lives before and after a dementia diagnosis.
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Works Cited

Alzheimer’s Association. “Medications for Memory, Cognition and Dementia-Related

Behaviors.” Alzheimer’s Disease and Dementia, Alz.org,

www.alz.org/alzheimers-dementia/treatments/medications-for-memory. Accessed

9 July 2021.

Cations, Monica, et al. "What does the general public understand about prevention and

treatment of dementia? A systematic review of population-based surveys." PLoS

ONE, vol. 13, no. 4, 2018, p. e0196085. Gale In Context: Opposing Viewpoints,

link.gale.com/apps/doc/A535337626/OVIC?u=dayt30401&sid=bookmark-

OVIC&xid=7a8cfaca. Accessed 8 July 2021.

Goodman, Ira L. "The current state of dementia prevention and treatment." Townsend

Letter, no. 393, 2016, p. 69+. Gale In Context: Opposing Viewpoints,

link.gale.com/apps/doc/A462508648/OVIC?u=dayt30401&sid=bookmark-

OVIC&xid=077ad72f. Accessed 10 July 2021.

Holden, Ellen, Charlotte R Stoner, and Aimee Spector. "Cognitive stimulation therapy

for dementia: Provision in National Health Service settings in England, Scotland

and Wales." Dementia, vol. 20, no. 5, 2021, pp. 1553-1564. OhioLINK Electronic

Journal Center, doi:10.1177/1471301220954611. Accessed 13 July 2021.

Krüger, Jenifer F. et al. “Probiotics for dementia: a systematic review and meta-analysis

of randomized controlled trials.” Nutrition Reviews, Volume 79, Issue 2, February

2021, Pages 160–170, Oxford Academic https://doi-

org.sinclair.ohionet.org/10.1093/nutrit/nuaa037. Accessed 9 July 2021.

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Maki, Y., Ohashi, W., Hattori, H. and Suzuki, T. (2021), “Discrepancies in persons with

dementia, family members, and physician perspectives of dementia treatment: a

descriptive study.” Psychogeriatrics, 21: 596-604. Wiley Online

Library. https://doi-org.sinclair.ohionet.org/10.1111/psyg.12710. Accessed 8 July

2021.

Mayo Clinic Staff. “Dementia - Diagnosis and Treatment - Mayo Clinic.” Mayoclinic.Org,

Mayo Clinic, 17 June 2021, www.mayoclinic.org/diseases-

conditions/dementia/diagnosis-treatment/drc-20352019. Accessed 3 July 2021.

Mental Health Weekly Staff "Antibiotics could be promising treatment for form of

dementia." Mental Health Weekly Digest, 27 Jan. 2020, p. 57. Gale In Context:

Opposing Viewpoints, link.gale.com/apps/doc/A612298018/OVIC?

u=dayt30401&sid=bookmark-OVIC&xid=46120468. Accessed 9 July 2021.

Simona, Chita Dana, et al. “Dance Movement Therapy Influence the Quality of Life

and Has Behavioral Improvements in Dementia Patients.” Ovidius University

Annals, Series Physical Education & Sport/Science, Movement & Health, vol. 20,

no. 2, July 2020, pp. 91–96. SPORTDiscus, search.ebscohost.com/login.aspx?

direct=true&db=s3h&AN=144645677&site=eds-live. Accessed 13 July 2021.

Wenborn, Jennifer, et al. "Community Occupational Therapy for people with dementia

and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in

Dementia [VALID]) study: A single-blind, randomised controlled trial." PLoS

Medicine, vol. 18, no. 1, 2021, p. e1003433. Gale In Context: Opposing

Viewpoints, link.gale.com/apps/doc/A653021783/OVIC?

u=dayt30401&sid=bookmark-OVIC&xid=b6268e73. Accessed 8 July 2021.

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Wu, Chen-Yi, et al. "The Effects of Anti-Dementia and Nootropic Treatments on the

Mortality of Patients with Dementia: A Population-Based Cohort Study in

Taiwan." PLoS ONE, vol. 10, no. 6, 2015. Gale In Context: Opposing Viewpoints,

link.gale.com/apps/doc/A418925434/OVIC?u=dayt30401&sid=bookmark-

OVIC&xid=b21ac1d9. Accessed 9 July 2021.