Medication treatments for dementia are limited at this time except for those conditions in which a treatable medical condition is identified.
Approved Medications
Different classes of medications are available for treating people with Alzheimer’s disease, but their limited effects relieve symptoms for only a temporary period. For dementia problems that are not cognitive or behavioral, there are limited options. For example, the combination of dextromethorphan and quinidine has been approved for treating “pseudobulbar affect,” an unstable emotional state, which is characterized by uncontrollable episodes of crying and/or laughing. Pimavanserin has been approved for treating psychosis in Parkinson’s disease.
Off Label Medications
For other behaviors such as aggression, depression, anxiety, and insomnia, many medications are used “off-label,” which means that the FDA has not determined the medication to be safe and effective for treating dementia, even though some research may suggest that the medication can help, and even though the medication has been proven safe and effective for other uses. Antidepressants or antipsychotics are off-label treatments for depression and psychosis, respectively. Antidepressants sometimes help. Antipsychotic medications are often avoided due to their recognized side effects, risks, and limited effectiveness in this role.
The medications that have been approved by the FDA for Alzheimer’s disease are also sometimes used to treat vascular dementia or Lewy body dementia, where they also can have mild benefits. Their effect on FTLD is less predictable.
Many other medications are being tested at present for the treatment of dementia. Perhaps before many years have passed we will have medications to treat, delay, or even cure some of these disorders.
Non-Medication Treatments
Even now, as we wait for more effective medications, we already have non-medication treatments that can be very helpful. Support groups and other forms of education or therapy can help a person adjust to the diagnosis of dementia. Planning ahead is very important and requires discussion of difficult topics such as when to give up driving, how to make the living environment safe and usable, what to do about financial matters, and what treatments are acceptable near the end of life. For people with non-cognitive behavior problems, the “DICE” model (Describe, Investigate, Create a plan, and Examine its effect) and other behavioral interventions have been helpful.