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Treatment of dementia

Authors
Daniel Press, MD
Michael Alexander, MD
Section Editors
Steven T DeKosky, MD, FAAN, FACP, FANA
Kenneth E Schmader, MD
Deputy Editor
April F Eichler, MD, MPH

INTRODUCTION

Advances in the understanding of the pathophysiology of dementing illnesses have changed the management of patients with these disorders from a conservative, symptomatic approach to a more biologically and medically specific one. The mainstay of management is still symptomatic: treatment of behavioral disturbances, environmental manipulations to support function, and counseling with respect to safety issues. The future promises disease-specific and, hopefully, disease-modifying treatments.

The first step in management is an accurate diagnosis of the type of dementia. (See "Evaluation of cognitive impairment and dementia".)

In the past, a rudimentary, and nearly always negative, work-up was conducted to rule out a "reversible" cause of dementia, leaving "senile dementia" as a default diagnosis. When no disease-specific treatments were available, that approach had a certain logic, but it is no longer adequate.

A more precise diagnosis is required for effective management and accurate prognosis. As an example, a practitioner who misdiagnoses "senile dementia" in a patient with progressive memory problems and visual hallucinations, overlooking very mild parkinsonism, might initiate treatment of hallucinations with haloperidol. This apparently sensible symptomatic treatment exposes the patient, who most likely has dementia with Lewy bodies (DLB), to severe and even life-threatening deterioration [1].

Addressing the treatment of behavioral and sleep problems is an important aspect of the care of patients with dementia. This topic is discussed separately. (See "Management of neuropsychiatric symptoms of dementia" and "Sleep-wake disturbances and sleep disorders in patients with dementia".)

                             

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Literature review current through: Nov 2016. | This topic last updated: Mon Jun 20 00:00:00 GMT+00:00 2016.
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