Abnormal Psychology

Cognitive Disorders 711

Treating Dementia

With most types of dementia, such as the Alzheimer’s type and vascular dementia,

no treatments can return cognitive functioning to normal. There is one exception

to this general situation: antiretroviral medications sometimes can signifi cantly re-

duce symptoms of dementia caused by HIV infection. However, as with amnestic

disorder, for most other types of dementia, treatment largely consists of rehabilita-

tion. Given the high proportion of dementia that is caused by Alzheimer’s disease

(see Table 15.12), in the following sections we focus on treatment for that type of

dementia, unless otherwise noted.

Targeting Neurological Factors

Medications have been developed to delay the progression of cognitive diffi culties in

people with Alzheimer’s disease. One class of drugs, cholinesterase inhibitors, such

asgalantamine (Razadyne) or donepezil (Aricept), is used for mild to moderate cog-

nitive symptoms; these medications increase levels of acetylcholine (American Asso-

ciation of Geriatric Psychiatry, 2006; Lanctôt et al., 2003; Lyle et al., 2008; Poewe,

Wolters, & Emre, 2006; Ritchie et al., 2004). Another type of drug, memantine

(Namenda), affects levels of glutamate (Tariot et al., 2004) and is used to treat mod-

erate to severe Alzheimer’s dementia (Kavirajan, 2009; Laks & Engelhardt, 2008).

Although these drugs can help some patients (Atri et al., 2008; Cummings, Mackell, &

Kaufer, 2008; Homma et al., 2008), they are new, and few carefully controlled stud-

ies of these medications have been completed. Moreover, it is unknown what the

long-term effects of these drugs may be (Langa, Foster, & Larson, 2004; Ringman &

Cummings, 2006). These medications may also be given to patients with dementia

due to Parkinson’s disease.

Antipsychotic medications are sometimes given for psychotic symptoms

or behavioral disturbances, but the side effects of both traditional and atypi-

cal antipsychotics have led researchers to be cautious in advising their long-term

use (Ballard & Howard, 2006; Schneider, Dagerman, & Insel, 2006). Patients

with dementia due to Lewy bodies should not be given antipsychotic medication

for behavioral disturbances because this type of medication makes their symp-

toms worse.

When patients have high blood pressure (which increases the risk of co- occurring

vascular dementia), they may also receive medications to treat that problem.

Targeting Psychological Factors

The American Association for Geriatric Psychiatry (2006) recommends

that the fi rst line of intervention for dementia should help patients main-

tain as high a quality of life as is possible given the symptoms. Such

interventions focus on psychological and social factors.

To target psychological factors, people in the early stages of dementia—

and their friends and relatives—may be taught strategies and given de-

vices to compensate for memory loss (such as those used for people with

amnestic disorder, described earlier). In addition, structured and predict-

able daily activities can reduce patients’ confusion (Spector et al., 2000).

Moreover, patients may be given a GPS tracking device to wear so that

they can be found relatively quickly and easily if they get lost (Rabin

et al., 2006).

The early stages of progressive dementias are often associated with

signifi cant anxiety and depression (Porter et al., 2003; Ross, Arnsberger, &

Fox, 1998). One type of treatment that may alleviate these comorbid

conditions is reality orientation therapy (Woods, 2004). This therapy is

designed to decrease a patient’s confusion by focusing on the here and

now. For example, the clinician may frequently repeat the patient’s name

(“Good morning, Mr. Rodrigues; how are you on this Monday morning,

People with dementia can wander off and become

confused about who they are and where their

home is. Some people with dementia wear small

GPS tracking devices, like the one in this sneaker,

so that if they wander off they can be found

relatively quickly and easily.

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