There is no cure for either vascular dementia or Alzheimer's disease. But there are some medications that may help slow the progression of these diseases. It is important for both the person with dementia and the person's caregiver to have a strong support system in place to deal with the emotional challenges of the disease.
Treatments are aimed at lessening the symptoms and slowing the progression of the disease. Treatment may include a combination of drug and psychiatric or behavioral therapies. If you are elderly, your doctor may pay close attention to the medications you take, because some drugs may cause confusion or delirium in older people. Exercise, both physical and mental, can slow the progress of dementia.
The following drugs have been approved to treat Alzheimer's disease. They are also often used to treat vascular dementia. However, not everyone responds to these medications. Research is continuing to find better drugs to treat Alzheimer's and other forms of dementia.
Cholinesterase inhibitors -- These drugs increase the amount of a brain chemical called acetylcholine, a messenger chemical that is involved in memory and judgment. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes
- Donepezil (Aricept)
- Rivastigmine (Excelon)
- Galantamine (Razadyne)
Memantine (Namenda) -- This drug works by regulating glutamate, a chemical messenger involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness.
Complementary and Alternative Therapies
Alternative therapies may help treat dementia. If you are deficient in some nutrients, taking a supplement or getting more of that nutrient in your diet may help slow the progression of the disease. Many of the nutrients and herbs listed are used due to their supposed effects of increasing blood flow to the brain. Not surprisingly, many of them have a blood-thinning effect and therefore can interfere or accentuate the effects of blood-thinning medications. Dementia therapies, pharmaceutical or natural, should be used under the supervision of a qualified doctor. If you are pregnant, or thinking of becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.
Nutrition and Supplements
- Phosphatidylserine (100 mg, 3 times per day), a substance that occurs naturally in the brain and shows promise in several studies. This supplement may increase levels of brain chemicals involved with memory. Do not take phosphatidylserine if you are taking anticoagulants (blood thinners), and use caution when combining it with ginkgo for the same reason. There are great differences in quality among phosphatidylserine supplements. More expensive brands tend to be better than cheaper brands. Phosphatidylserine can interact with some medications, including those typically used to treat Alzheimer's disease. Talk to your doctor.
- Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some studies, but not all, vitamin E (400 - 800 IU per day), combined with Aricept, helped slow cognitive decline in people with Alzheimer's disease. Another antioxidant, coenzyme Q10 (10 to 50 mg, 3 times per day), may also help the brain get more oxygen. Coenzyme Q10 can increase the clotting tendency of the blood. Check with your doctor to make sure it's suitable for you. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented doctors recommend eating half a cup of frozen blueberries daily. Some nutritionally-oriented doctors believe that freezing improves absorption of the antioxidants in the skin.
- B Vitamins: biotin (300 mcg); B1 (50 to 100 mg), B2 (50 mg), B6 (50 to 100 mg), B12 (100 to 1,000 mcg), folic acid (400 to 1,000 mcg). These vitamins facilitate the making of several neurotransmitters (chemical messengers) necessary for proper brain function. No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often elevated in Alzheimer's patients. Injections of B12 may have the best results.
- Zinc (30 to 40 mg per day) is often deficient in elderly people, and correcting real deficiencies may help improve memory.
- L-arginine: Evidence suggests that this amino acid may help in vascular dementia by increasing blood flow to the brain. Arginine may worsen herpes infections, and can interfere with some medications, including Viagra, medications that increase blood flow to the heart, such as Nitrates, as well as antihypertension medicines.
- Essential fatty acids, such as those found in alpha linoleic acid (ALA), borage oil, and evening primrose oil: These omega-3 fatty acids may help reduce the risk of Alzheimer's disease. Dietary changes include eating fewer animal fats and more fish. Supplementing with omega-3 fatty acids can have many health benefits, but it can also increase the risk of bleeding, particularly in people who are taking blood-thinning medications, including warfarin (Coumadin), aspirin, and others.
- Melatonin: Studies suggest that melatonin, particularly when combined with physical exercise, protects against behavioral and psychological symptoms of dementia, including anxiety, a lack of exploration, and emotionally. It also protects the brain against cognitive impairment and oxidative stress. Melatonin interacts with several medications. Speak with your physician.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. Always tell your doctor about any herbs you may be taking.
- Ginkgo (Ginkgo biloba) shows the best evidence for treating early Alzheimer's disease and vascular dementia. It may be taken in a standardized extract of 40 - 50 mg, 3 times per day. If you are taking blood-thinning medication, or have a history of seizures, use ginkgo only under the supervision of your doctor.
- Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. However, more studies are needed to know for sure. The usual dose is 200 mcg, twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia. Huperzine can potentially interact with several medications. Speak with your physician.
- Lemon balm (Melissa officinalis): One study showed that this herb helped improve cognitive function in people with mild-to-moderate Alzheimer's. The dose used was 60 drops per day. Lemon balm can interact with sedative medications.
- Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have investigated how bacopa might affect symptoms of dementia. One study found that taking 300 mg of bacopa per day for 12 weeks seemed to improve cognition in healthy people. Bacopa can potentially decrease heart and lung function, as well as slow the heart rate. Speak with your physician.
- Lavender may be effective in terms of alleviating agitation associated with dementia. Lavender is not used internally, but rather as an aromatherapy agent.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for treating dementia. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for dementia are listed below.
- Alumina -- for dullness of mind, vagueness, slow answers to questions
- Argentum nitricum -- for dementia with irritability, especially with lack of control over impulses
- Cicuta -- for dementia after head injuries, especially with convulsions
- Helleborus -- for stupefaction, when a person answers questions slowly and stares vacantly
- Silica -- for mental deterioration with anxiety over small details
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