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1. Management & Treatment of
Dementia

2. Guiding principles
 Early diagnosis.
 Find out treatable causes
 Optimization of physical
health, cognition activity and well
being.
 Detection and treatment of BPSD.
 Educating care taker and providing
long term support to care taker

3. Diagnosis
Initial evaluation: Further tests as
 MRI of brain, possibly also indicated:
CT  Lumbar puncture
 ESR, CRP  Antibodies: ANA, anti-
 complete blood count and dsDNA,
smear  Intestinal biopsy, brain
 Na, K, Ca, glucose biopsy
 Serum electrophoresis  Urine screening for amino
 LFT acids and disorders of
carbohydrate metabolism
 HIV, syphilis
serology, Lyme, herpes  Genetic analysis
simplex, and other
serological test
 Thyroid function test
 Vitamin B12, folic acid

4. Imp Drugs
 Cholinesterase Inhibitors (ChEIs)
donepezil, rivastigmine and
galantamine.
 The NMDA receptor antagonists
(memantine)
 Moderate to severe stages of AD and
VaD
 Useful to improve cognitive function
and behavioral symptoms

5. MOA, dose
 Rivastigmine – Inhibits AChE and
BuChE, that predominates in brain, Dose:
Intially 1.5mg BD, increases every 2
weeks by 1.5mg/day upto 6 mg/BD
 Donepezil – cerebroselective & reversible
anti – AChE, Dose: 5mg OD HS
 Galantamine – natural alkaloid, anti –
AChE, Dose: 4mg BD
 Memantine – NMDA receptor
antagonist, appears to block excitotoxicity
of glutamate, Dose: start with 5mg
OD, increase upto 10mg BD, stop if no
clinical benefit in 6 months

6. Misc Drugs
 Piractem, Pyritinol, Dihydroergotoxine.

7. Behavioral and Psychological
Symptoms of Dementia (BPSD)
 Atypical anti-psychotics
 SSRI
 Carbamazepine
 Simple low-cost strategies to manage
BPSD. Ex: massage, music and
aroma therapy

8. Support for Care takers
 Psycho-educational
interventions, many of which include
an element of care taker training.
 Psychological therapies e.g. cognitive
behavioral therapy (CBT), and
counseling.
 Care taker support and care.

9. Evidence based Rx
 Partially effective treatments are
available for most core symptoms of
dementia.
 Symptomatic, but do not alter the
progressive course of the disease.
 Importantly, psychological and
psychosocial interventions (sometimes
referred to as 'non-pharmacological'
interventions) may be as effective as
drugs, but have been less extensively
researched, and much less effectively
promoted.

10. Modifiable risk factors
 Role of cardiovascular risk factors (CVRF)
and cardiovascular disease (CVD) in the
aetiology of dementia and AD.
 Smoking increases the risk of AD.
 Midlife hypertension and
hypercholesterolemia are associated with
AD onset in later life.
 Diabetes
 Atherosclerosis and AD are linked disease
processes, with several common underlying
factors (the APOE e4
gene, hypertension, increased fat intake
and obesity, raised