Alzheimer Dementia: Treatment

00:00 How do we treat Alzheimer's disease? Well, the first and most important is lifestyle modifications. Regular sleep is critically important. Sleep is one of the periods of time where the brain clears abnormal proteins and processes waste and adequate sleep is an important aspect of modifying future dementia risk. Maintaining good physical health is critically important. A physically active body leads to a mentally active mind. Memory training can be helpful. The really physical activity is one of the most important mechanisms of disease modification early in the course of the disease. But back to the idiom of either use it or lose it, mental activity and mental training is important in patients with cognitive dysfunction. And physical activity is really critical. There are also pharmacologic treatments. Cholinesterase inhibitors have been the most widely available and used medications for mild to moderate symptoms. This includes medications like donepezil, rivastigmine, and galantamine. These agents increase the amount of acetylcholine at the synaptic cleft and can improve cognitive function. There is minimal improvement in cognition over a long period of time. The studies looking at these drugs evaluated symptomatic improvement at 6 months. These medications are approved to treat mild and moderate forms of the disease, but are unlikely to improve with patients who have severe dementia. In addition, the NMDA antagonist, memantine, can also be used to treat patients with Alzheimer's disease. It's typically used for patients with moderate to severe dementia. In addition, we want to treat some of the other comorbid conditions that can occur in these patients including behavioral changes and abnormalities. Low-dose antipsychotics are often used to control agitation, hallucinations, or other related symptoms. The selective serotonin reuptake inhibitors can be important for managing depression which can masquerade as dementia or co-occur in patients who have dementia. And then there's been a lot of testing and excitement about the use of monoclonal antibodies to beta-amyloid or tau that will alter the underlying pathology in the brain. There's been some early approval of these agents. An example is aducanumab and a lot of excitement in developing these agents further for Alzheimer's dementia. Now let's talk about how we classify dementias and talk about some of the non-Alzheimer's types of dementias. Again, going back to this important table, there are both inherited and acquired dementias.

02:36 The inherited dementias include Alzheimer's disease as well as a number of other neurodegenerative conditions where dementia is a prominent feature.

02:44 Frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease dementia, and then dementia with other neurodegenerative conditions as well as Huntington's. There are a number of acquired dementias that are important to recognize and vascular dementia is probably one of the most important to remember.