Are there any drugs that cause dementia?

Psychiatry, psychosomatics & psychotherapy

Drug therapy for Alzheimer's dementia

In order to transmit and process information, the brain needs certain proteins, which are used for communication between nerve cells. A lack of these messenger substances in the brain, especially acetylcholine, seems to cause the symptoms of Alzheimer's dementia, among other things. The drug therapy is therefore usually carried out with so-called (acetyl) cholinesterase inhibitors (e.g. galantamine, rivastigmine and donepezil), which have been particularly well researched. The cholinesterase inhibitors block an enzyme that is responsible for breaking down acetylcholine - the so-called cholinesterase. The result is that the concentration of the messenger substance acetylcholine increases in the brain. In addition to inhibiting enzymes, galantamine also has an effect on so-called nicotinic receptors and thus promotes the binding of acetylcholine to the nerve cells. Studies have shown that the use of a cholinesterase inhibitor does not temporarily worsen or even improve overall symptoms such as memory disorders, information processing disorders, everyday skills and behavioral disorders. This makes it much easier to care for the patient. Memory loss can be delayed by about 1 to 2 years with these active ingredients compared to non-treatment. So-called glutamate antagonists (e.g. memantine) take a different approach with regard to the mechanism of action. These substances block the glutamate receiving points at the synapses (connection between two nerve points) and thus inhibit the transmission of excitation to the nerve cells, which are regulated by glutamate. The active ingredient shows a stabilization of the general level of performance over a period of 6 months in moderately and severely demented Alzheimer's patients.

Often, supplements such as vitamins A, C, E and gingko biloba are used in the treatment of Alzheimer's patients. The effectiveness of these substances has not been scientifically proven.

In order to assess whether the medication is working, the specialist will carry out an initial check-up two to three months after the start of therapy. Since the brain performance of those affected can fluctuate even without drug therapy, a preparation is given for at least three months and only then is the success or failure of the therapy judged. However, the lack of improvement does not mean that the drug is not working. It is more likely that brain performance would be worse without the drug.

About 80% of those affected are noticed by serious changes in behavior in the course of the disease: They abuse relatives, for example, nag constantly, but also physically defend themselves against well-intentioned assistance, e.g. by hitting, spitting, scratching. They distrust their relatives when they want to steal from them or they walk around restlessly at night because they don't know whether it is day or night or they feel threatened. These behavioral disorders can now be treated well at any stage. Risperidone is the only modern neuroleptic to be approved by the drug authorities for the treatment of dementia-accompanying behavioral disorders such as severe aggression, delusions and hallucinations. The patient stays awake and active during the day with risperidone, which reduces the risk of falling.

Mood-enhancing agents (e.g. antidepressants, especially selective serotonin reuptake inhibitors) are also used to treat depression, symptoms of anxiety or reduce drive in dementia.

Benzodiazepines are generally not suitable as sedatives. Not only can they lead to dependency, but instead of the desired calming effect they can trigger so-called paradoxical reactions, i.e. the patient may react with strong excitement. In addition, the already limited mental abilities of those affected are further impaired.

In addition to anti-dementia therapy and the treatment of behavioral disorders, treatment of possible underlying diseases such as high blood pressure, diabetes, lipid metabolism disorders and accompanying physical complaints such as loss of bladder control (incontinence) should be carried out. A balanced diet and adequate fluid intake should be ensured.

In order to stay mobile, Alzheimer's patients can also receive physiotherapy. Among other things, it promotes movement coordination, body awareness and drive. Logotherapy with breathing training can also be helpful for speech and swallowing problems.

Technical support: Priv.-Doz. Dr. med. Juraj Kukolja, Cologne