Treating Dementia

08/18/2010

A diagnosis of thinking problems or dementia requires a thorough examination and often specific tests as listed in the box below. An evaluation by a Neuropsychologist, a specialist trained in evaluating thinking and behavioral functions, can help diagnose cognitive difficulty or dementia.

Neuropsychological testing measures thinking abilities such as concentration, attention, memory, language abilities, abstract thinking, spatial skills, and executive functions. These tests can help your physician determine the cause of thinking problems.

Medical tests typically checked when cognitive changes occur are: Brain MRI or CT scan, Vitamin B12, Thyroid Function, Liver Function, Folate, Blood Count, Kidney Function, Electrolytes and Blood Glucose level

Medications used to treat cognitive problems

Acetylcholinesterase inhibitors increase levels of memory chemical acetylcholine
NMDA Blockers recude the effects of the neurochemical glutamate

There are medicines that can be used to treat dementia. Medications such as rivastigmine (Exelon) or donepeziol (Aricept) belong to a class of medicines called acetylcholine esterase inhibitors. These medicines boost brain levels of the memory neurotransmitter acetylcholine. Thet can help thinking functions and sometimes improve symptoms of apathy and hallucinations when they are also present. Exelon, FDA approved for use in Parkinson’s dementia, is available as a pill or patch. Side effects include nausea, diarrhea and stomach upset. These medicines may not be safe for you if you have a specific heart problem (heart block), history of bleeding ulcers or seizures. Memantine (Namenda) is a different class of medicines that work by blocking the neurotransmitter glutamate. This medicine is sometimes used with the ones described above to treat advancing Alzheimer’s disease. This medicine is not yet FDA approved for Parkinson’s dementia but is being actively studied.

Visual hallucinations caused by Parkinson’s medicines are more common when thinking problems are present. These hallucinations are usually visual illusions of movement or well formed objects such as animals or people. Visual hallucinations are treated by treating any underlying illness such as a bladder infection, dehydration or infection, and if possible reducing medications that cause thinking problems. Sometimes it is necessary to treat hallucinations with a medicine. The antipsychotics quetiapine (Seroquel) or clozapine (Clozaril) are sometimes used to treat hallucinations. These medicines should be used with caution and may require close monitoring of other conditions. In addition, clozapine can cause a rare but potentially fatal drop in white blood cell count so periodic blood tests are required.

Other antipsychotics should not be used as they can worsen parkinsonian movement problems. A partial list is included in the Be prepared for your hospital visit document.

The saying ‘use it or lose it’ applies to your body and mind.

Although there are medicines to help with thinking functions, it is equally important to look at other activities and life habits that can improve cognitive function. A rehabilitation team can help you exercise safely, enhance your ability to perform daily activities, and improve communication and language skills. See the comprehensive care worksheet to see how these team members can ghelp you. Then talk to your doctor about getting a referral to one of these specialists if needed.

Surprisingly, cognitive challenges or brain puzzles are not the only exercises that help thinking functions. Physical exercise is proven to help not just the physical body but also the mind and reduce the risk of dementia. Just as physical exercise can improve movement and strength, brain exercises can help prevent dementia and its progression. The brain has specialized areas that control movement, language, memory, vision, planning, multitasking, problem solving, coordination, creativity, interpretation of our surroundings and visuospatial skills. Many types of puzzles, games (popular videogames now have brain teasers and games designed for brain fitness); art projects and music can enhance function in these specialized areas.

Diet is also important for cognitive health. Fruits and vegetables are important especially those high in vitmain E, vit B6 and 12. Although it is not clear if diet changes can reverse or slow memory loss, a poor diet and certain vitamin deficiencies can cause confusion, a sense of sluggishness and worsen fatigue. These can, in turn, affect your concentration and ability to keep your attention sharp. Information on nutrition and diet tips can be found in the nutrition section.

Sleep problems, anxiety and depression can also cause mental sluggishness, decrease in attention and poor concentration to a degree that a person can display memory or thinking problems.

Take the cognitive challenge. Print a copy of the Cognitive Challenge Worksheet. Select one or two things that you and your family can add change or work on to enhance your cognitive health.

Author: Monique Giroux, MD

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