Dementia treatment: Medication, therapy, and lifestyle

As a 2023 review explains, one of the most exciting medical advancements for treating dementia is a drug called “lecanemab”, which appears to slow cognitive decline in people with early stage Alzheimer’s disease — the most common form of dementia.

The Food and Drug Administration (FDA) explains that lecanemab is an amyloid beta-directed antibody, meaning it binds to amyloid-beta plaques in the brain. In clinical trials, this drug significantly reduced the rate of cognitive decline in people with mild cognitive impairment or mild dementia.

The two main drug treatments for dementia are cholinesterase inhibitors and memantine (Namenda).

Memantine works by blocking the effects of the neurotransmitter glutamate. Too much glutamate in the brain can cause nerve cells to become overexcited, which can damage or kill brain cells. By blocking glutamate, memantine can help reduce dementia symptoms and slow the progression of the disease.

A 2022 review outlines some non-pharmacological therapies that may help to maintain cognitive function in people with dementia. These include:

CST includes activities and exercises that promote thinking, concentration, communication, and memory recall. A 2023 meta-analysis found that, among people with mild to moderate dementia, CST was associated with clinically relevant improvements in communication and social interaction, and small, short‐term improvements in cognition.

MCRP is a cognitive rehabilitation program that combines multiple disciplines to help manage different dementia symptoms. These disciplines may include:

RO involves presenting individuals with information on the current time and place to help orient them to the present moment. According to a 2022 review, RO may help improve cognition and adherence to drug treatment in people with mild to moderate AD.

The following lifestyle modifications may be beneficial for people living with dementia:

A 2021 study investigated the effects of a 6-month physical exercise program on people with dementia. Compared to a control group who received their usual care, the exercise intervention group showed improvements in functional capacity, quality of life, and neuropsychiatric symptoms.

A 2023 review notes that while no diet definitively prevents dementia, a healthy, balanced diet may help to decrease the risk of cognitive decline. Two diets that appear to show the most promise are the Mediterranean diet and the ketogenic diet.

A Mediterranean diet includes plenty of fruits, vegetables, and grains and features olive oil as the primary fat source. A 2023 postmortem study found that individuals who had followed a Mediterranean diet during their lifetime showed fewer signs of AD pathology at postmortem compared to those who did not.

The ketogenic diet is a low-carbohydrate, moderate-protein, high fat diet. A 2023 review notes that a ketogenic diet may promote the synthesis of proteins that support neuron growth and survival, and may increase production of the molecule “adenosine triphosphate (ATP)”, which is essential for proper brain function. However, further research is necessary to establish whether a ketogenic diet can protect against neurocognitive decline.

People with dementia may tend to withdraw from activities and social interactions, which can greatly impact their quality of life. Cognitively stimulating activities can provide a sense of purpose and routine and help the person maintain some independence. They can also boost self-esteem and overall well-being.

Examples of cognitive stimulation activities that people may do alone or in small groups include:

• singing songs
• listening to music
• painting
• watching films
• reading
• playing word games
• completing puzzles
• baking
• gardening
• reminiscing about the past

There is currently no cure for dementia, and current treatments focus on managing the symptoms and slowing the progression of the disease.

Current medical treatments include medications such as cholinesterase inhibitors and memantine. Most recently, a drug called “lecanemab” has shown promise in reducing the rate of cognitive decline in people with mild dementia.

Some non-pharmacological therapies may help prolong cognitive function in people with dementia. They include cognitive and behavioral therapies, and lifestyle modifications like being active, eating a nutritious, balanced diet, and engaging in cognitively stimulating activities.