At the present time, the three most common forms of dementia…Alzheimer’s disease, vascular dementia, and Lewy Body dementia…have no cure. But researchers are working on exciting new approaches to treatment that could soon prove effective in preventing, stopping, or curing the diseases.
Reversible Forms of Dementia
Is dementia reversible? Sometimes, since some forms of dementia are caused by temporary physical conditions. Once the underlying issue is addressed, the cognitive problems may go away. The following are all causes of reversible dementia:
- Stress, depression, and anxiety
- Leaking cerebrospinal fluid
- Drug interactions or side effects
- Urinary tract infections
- Lack of physical and/or social interaction
- Alcohol abuse
- Sleep disorders
- Nutritional deficiencies
- Brain infections
- Metabolic disorders or hormonal imbalances
- Chronic pain
- Oxygen deprivation stemming from heart or lung disease
- Brain surgery
If you begin experiencing what seem like dementia symptoms, it’s always best to confront them head-on. Irreversible forms of dementia are best treated as early as possible to delay the disease’s progress. Plus, when you approach your doctor with concerns about your cognition, a first step will be to rule out the reversible causes listed above…and treating these early is also important, since they carry other health effects. Besides, the longer the underlying condition is allowed to persist, the greater the chances it’ll cause permanent cognitive deficits.
Imagine the relief you’d feel if, after an honest conversation with your doctor, you found that you were merely suffering the effects of hypothyroidism or a vitamin B12 deficiency, both of which are eminently treatable. Taking care of them should allow your cognitive symptoms to resolve completely. And again, if the news were not so good, at least you’d be giving yourself the earliest possible start to treating a more serious condition.
Existing Dementia Treatments
Today, we have more treatment options for Alzheimer’s and other dementias than ever before. Unfortunately, none of them is a cure, but some have been proven to improve symptoms, modify the disease, or slow its progress. Most such treatments are targeted at Alzheimer’s, since it’s by far the most common form of irreversible dementia. We’ve had drugs to treat the symptoms of Alzheimer’s for about 30 years now, but recently, new medications aimed at modifying the disease itself have been developed. Bear in mind that all of these drugs have side effects, some of them severe, and that your health conditions and other risk factors, as well as the drugs you’re currently taking, can affect whether your doctor chooses to prescribe them.
Drugs designed to treat symptoms include:
- Donepezil (Aricept), for people with mild to severe Alzheimer’s. Donepezil is a cholinesterase inhibitor, a class of drugs that supports the action of a brain chemical, called acetylcholine, which is required for the proper communication from one brain cell to another. It helps with memory and attention, and it allows some people to continue managing their daily tasks independently. It’s taken either as a once-a-day pill or as a skin patch.
- Rivastigmine (Exelon), also a cholinesterase inhibitor. It’s approved for those whose Alzheimer’s is mild to moderate, as well as for people diagnosed with Parkinson’s who have dementia with the condition. It’s taken twice daily or as a patch.
- Galantamine (Razadyne), another cholinesterase inhibitor that improves cognition in mild-to-moderate Alzheimer’s or people whose dementia is a mix of Alzheimer’s and vascular dementia. It’s taken daily.
- Memantine (Namenda), for moderate to severe Alzheimer’s. Memantine is an NMDA receptor antagonist, meaning it inhibits a brain chemical called glutamate which can be toxic to brain cells in excessive quantities. It helps people perform daily functions and provides modest improvements to cognition.
- Brexpiprazole (Rexulti), an antipsychotic medication approved in 2023 to calm the agitation often experienced by people with Alzheimer’s. Taken orally.
- Suvorexant (Belsomra), to treat insomnia in people with Alzheimer’s.
- Selective serotonin reuptake inhibitors (SSRIs), commonly prescribed to treat depression, may be used to reduce irritability and anxiety in people with Alzheimer’s.
- Mood stabilizers, used in people with seizures or bipolar I or II, can reduce aggression, hallucinations, and agitation for people diagnosed with dementia.
Newer drugs designed to remove the amyloid plaques and tau tangles in the brain that are characteristic of Alzheimer’s include the following:
- Aducanumab (Aduhelm), a monoclonal antibody delivered via IV infusion. It was the first drug approved (in 2021) to remove amyloid plaque from the brains of people with Alzheimer’s. Unfortunately, while it did reduce the amount of plaque, its effects on cognition were disappointing, and its use was associated with risk of brain bleeding. Its manufacturer, Biogen, is discontinuing the drug in 2024.
- Lecanemab (Lequembi), another monocolonal antibody delivered by infusion, removes both amyloid plaque and tau tangles in the brains of people with early-stage Alzheimer’s. In clinical trials, it slowed the rate of cognitive decline by 27%, but real-world data on its efficacy are still coming in. And both lecanemab and aducanumab have been associated with brain shrinkage, leaving lecanemab’s future uncertain.
Dementia Drugs in the Pipeline
Fortunately, a few experimental drugs appear to show great promise and, if all goes well, will be available soon. They include:
- Donanemab, yet a third monoclonal antibody that targets amyloid plaques. It has not yet been approved as of this writing but is expected to receive FDA approval sometime in 2024. In a clinical trial, it was 60% more effective than placebo at slowing cognitive decline, and nearly half of people who started taking the medication in the earliest stages of Alzheimer’s saw no disease progression at the one-year mark.
- Remternetug, shown in early studies to safely and effectively remove beta-amyloid plaques from the brain. Studies are ongoing to see if it also alleviates symptoms for people diagnosed with early-Alzheimer’s. Researchers expect to release those results sometime in 2025.
- ALZ-801, which will receive an actual name if it continues down the pipeline. It’s designed not to remove plaques but rather to prevent them from forming in the brains of people with early- Alzheimer’s whose genetic profiles put them at high risk.
- Dexmedetomidine (Igalmi), already approved for agitation in people with schizophrenia and bipolar. Taken as a dissolvable strip placed under the tongue.
- AX-05, an investigative drug designed to prevent agitation.
- AVP-79, a twice daily drug shown in trials to reduce episodes of agitation in people with Alzheimer’s.
Other research is focused on different approaches, including attempts to stimulate the growth of new brain cells in the hippocampus…alter brain enzymes to cause them to produce fewer amyloid plaques…create vaccines that target amyloid and tau…develop antibodies to prevent Alzheimer’s and frontotemporal dementia…and even use semaglutide, currently marketed as obesity drug Wegovy, against Alzheimer’s.
Non-Pharmaceutical Dementia Treatments
Drugs are not the only way to treat dementia. Other techniques include:
- Cognitive Rehabilitation Therapy, which provides people with early-stage dementia with problem-solving strategies to manage daily tasks and maintain their independence.
- Cognitive Stimulation Therapy, which provides brain exercises such as puzzles and games for people with dementia to prolong function.
- Reminiscence Therapy, which uses conversations about the past, as well as such prompts as music, keepsakes, scrapbooks, and photos, to keep memories alive as well as to improve mood.
- Occupational Therapy, which equips people with strategies for working around their new challenges so they can keep performing their daily activities.
- Music Therapy, which is effective in managing the behavioral symptoms of dementia.
