There is no cure for either vascular dementia or Alzheimer disease. But medications 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. In addition, preliminary studies suggest aromatherapy (using aromas and scents), listening to or playing music, and using art therapy, may help improve symptoms.
The following drugs have been approved to treat Alzheimer 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 disease 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. Practitioners use many of the nutrients and herbs listed because of 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. Use dementia therapies, pharmaceutical or natural, under the supervision of a qualified doctor. If you are pregnant, or thinking of becoming pregnant, do not use any complementary and alternative therapies (CAM) unless directed to do so by your physician.Nutrition and Supplements
- Phosphatidylserine, 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. Quality among phosphatidylserine supplements differs. More expensive brands tend to be better than cheaper brands. Phosphatidylserine can interact with some medications, including those typically used to treat Alzheimer disease, glaucoma and other conditions. 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, combined with Aricept, helped slow cognitive decline in people with Alzheimer disease. Another antioxidant, coenzyme Q10 (CoQ10), may also help the brain get more oxygen. CoQ10 can increase the clotting tendency of the blood. Check with your doctor to make sure it is 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, B1, B2, B6, B12, folic acid. 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 patients. Injections of B12 may have the best results.
- Zinc is often deficient in elderly people, and correcting real deficiencies may help improve memory. Excessive amounts of zinc may suppress the immune system and throw off the balance of certain minerals in the body.
- 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 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 depression. 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 disease and vascular dementia. 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 dementia, according to several studies in China. However, more studies are needed to know for sure. DO NOT take huperzine A if you have liver disease, epilepsy, asthma or lung issues, ulcers or problems with the urinary tract, 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 60 drops of this herb daily helped improve cognitive function in people with mild-to-moderate Alzheimer disease. 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 and potentially lead to gastrointestinal congestion. Speak with your physician.
- Smelling 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, includes 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.
Akhondzadeh S, Noroozian M, Mohammadi M, et al. Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomised, placebo controlled trial. J Neurol Neurosurg Psychiatry. 2003;74:863-6.
Akhondzadeh S, Sabet MS, Harirchian MH, et al. Saffron in the treatment of patients with mild to moderate Alzheimer's disease: a 16-week, randomized and placebo-controlled trial. J Clin Pharm Ther. 2010;35(5):581-8.
Akhondzadeh S, Shafiee Sabet M, Harirchian MH, et al. A 22-week, multicenter, randomized, double-blind controlled trial of Crocus sativus in the treatment of mild-to-moderate Alzheimer's disease. Psychopharmacology (Berl). 2010;207(4):637-43.
Albanese E, Dangour AD, Uauy R, et al. Dietary fish and meat intake and ementia in Latin America, China, and India: a 10/66 Dementia Research Group population-based study. Am J Clin Nutr. 2009;90(2):392-400.
Chen LP, Wang FW, Zuo F, et al. Clinical research on comprehensive treatment of senile vascular dementia. J Tradit Chin Med. 2011;31(3):178-81.
da Rocha MD, Viegas FP, Campos HC, et al. The role of natural products in the discovery of new drug candidates for the treatment of neurodegenerative disorders II: Alzheimer's disease. [Review]. CNS Neurol Disord Drug Targets. 2011;10(2):251-70.
Davis DH, Muniz Terrera G, Keage H, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012;135(Pt 9):2809-16.
Eckert GP. Traditional used Plants against Cognitive Decline and Alzheimer Disease. Front Pharmacol. 2010;1:138.
Forrester LT, Maayan N, Orrell M, et al. Aromatherapy for dementia. Cochrane Database Syst Rev. 2014;2:CD003150.
Freund-Levi YF, Eriksdotter-Jonhagen M, Cederholm T, et al. Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD Study. Arch Neurol. 2006;63:1402-8.
Garcia-Mesa Y, Gimenez-Llort L, Lopez LC, et al. Melatonin plus physical exercise are highly neuroprotective in the 3xTg-AD mouse. Neurobiol Aging. 2012;33(6):1124.e13-29.
Geng J, Dong J, Ni H, et al. Ginseng for cognition. [Review]. Cochrane Database Syst Rev. 2010;(12):CD007769.
Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13-23.
Hao Z, Liu M, Liu Z, et al. Huperzine A for vascular dementia. [Review]. Cochrane Database Syst Rev. 2009;(2):CD007365.
Hsieh MT, Peng WH, Wu CR, et al. Review on experimental research of herbal medicines with anti-amnesic activity. [Review]. Planta Med. 2010;76(3):203-17.
Hudson S, Tabet N. Acetyl-l-carnitine for dementia. Cochrane Database Syst Rev. 2003;CD003158.
Jesky R, Hailong C. Are herbal compounds the next frontier for alleviating learning and memory impairments? An integrative look at memory, dementia and the promising therapeutics of traditional Chinese medicines. [Review]. Phytother Res. 2011;25(8):1105-18.
Jung HA, Min BS, Yokozawa T, et al. Anti-Alzheimer and antioxidant activities of Coptidis Rhizoma alkaloids. Biol Pharm Bull. 2009;32(8):1433-8.
Kelley R, Minagar A. Memory Complaints and Dementia. Medical Clinics of North America. 2009;93(2).
Landin J, Frolich L, Schwarz S. Use of alternative therapies in patients with dementia and mild cognitive impairment: a prospective, controlled study. Int J Geriatr Psychiatry. 2008;23(11):1163-5.
Lin PW, Chan WC, Ng BR, et al. Efficacy of aromatherapy (Lavandula angustifolia) as intervention for agitated behaviours in Chinese older persons with deementia: a cross-over randomized trial. Int J Geriatr Psychiatry. 2007;22(5):405-10.
Lin Z, Gu J, Xiu J, et al. Traditional Chinese medicine for senile dementia. Evid Based Complement Alternat Med. 2012;2012:692621.
Mazereeuw G, Lanctot KL, Chau SA, et al. Effeccts of w-3 fatty acids on cognitive performance: a meta-analysis. Neurobiol Aging. 2012;33(7):1482.e17-29.
Mirabella G. Is art therapy a reliable tool for rehabilitating people suffering from brain/mental disease? J Altern Complement Med. 2015;21(4):196-9.
Mohajeri MH, Troesch B, Weber P. Inadequate supply of vitamins and DHA in the elderly: imlications for brain aging and Alzheimer-type dementia. Nutrition. 2015;31(2):261-75.
Napryeyenko O, Borzenko I. Ginkgo biloba special extract in dementia with neuropsychiatric features: a randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung. 2007;57:4-11.
Park SY. Potential therapeutic agents against Alzheimer's disease from natural sources. [Review]. Arch Pharm Res. 2010;33(10):1589-609.
Petrovsky D, Cacchione PZ, George M. Review of the effect of music interventions on symptoms of anxiety and depression in older adults with mild dementia. Int Psychogeriatr. 2015;27(10):1661-70.
Piau A, Nourhashémi F, Hein C, et al. Progress in the development of new drugs in Alzheimer's disease. J Nutr Health Aging. 2011;15(1):45-57.
Rist PM, Chalmers J, Arima H, et al. Baseline cognitive function, recurrent stroke, and risk of dementia in patients with stroke. Stroke. 2013;44(7):1790-5.
Samaras N, Samaras D, Frangos E, et al. Dementia prevention: potential treatments and how to target high risk patients. Rev Med Suisse. 2013;9(387):1116-9.
Schrijvers EM, Buitendijk GH, Ikram MK, et al. Retinopathy and risk of dementia: the Rotterdam Study. Neurology. 2012;79(4):365-70.
Scripnikov A, Khomenko A, Napryeyenko O. Effects of Ginkgo biloba extract EGb 761 on neuropsychiatric symptoms of dementia: findings from a randomised controlled trial. Wien Med Wochenschr. 2007;157:295-300.
Snitz BE, O'Meara ES, Carlson MC, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 2009;302(24):2663-70.
Stough C, Lloyd J, Clarke J, et al. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology. 2001;156:481-4.
Sun Y, Lu CJ, Chien KL, et al. Efficacy of multivitamin supplementation containing vitamins B(6) and B(12) and folic acid as adjunctive treatment with a cholinesterase inhibitor in Alzheimer's disease: a 26-week, randomized, double-blind, placebo-controlled study in taiwanese patients. Clin Ther. 2007;29:2204-14.
Thal LJ, Calvani M, Amato A, et al. A 1-year controlled trial of acetyl-l-carnitine in early-onset AD. Neurology. 2000;55:805-10.
Ven Murthy MR, Ranjekar PK, Ramassamy C, et al. Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: ashwagandha. [Review]. Cent Nerv Syst Agents Med Chem. 2010;10(3):238-46.
Wang BS, Wang H, Song YY, et al. Effectiveness of standardized ginkgo biloba extract on cognitive symptoms of dementia with a six-month treatment: a bivariate random effect meta-analysis. Pharmacopsychiatry. 2010;43(3):86-91.
Weinmann S, Roll S, Schwarzbach C, et al. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. [Review]. BMC Geriatr. 2010;10:14.
Whitmer RA, Karter AJ, Yaffe K, et al. Hypoglycemic episodes and risk dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301(15):1565-72.
Wu TY, Chen CP, Jinn TR. Traditional Chinese medicines and Alzheimer's disease. [Review]. Taiwan J Obstet Gynecol. 2011;50(2):131-5.
Yoshiyama K, Arita H, Suzuki J. The Effect of Aroma Hand Massage Therapy for People with Dementia. J Altern Complement Med. 2015;21(12):759-65.
Zhang Z, Wang X, Chen Q, et al. Clinical efficacy and safety of huperzine Alpha in treatment of mild to moderate Alzheimer disease, a placebo-controlled, double-blind, randomized trial. Zhonghua Yi Xue Za Zhi. 2002;82:941-4.