Therapeutic treatment 

Three acetylcholinesterase inhibitors (AChEIs), donepezil, rivastigmine and galantamine, are recommended by NICE for mild and moderate Alzheimer’s disease. Side effects with AChEIs include diarrhoea, nausea, possible vomiting and nasal rhinitis, muscle cramps, fatigue, insomnia and dizziness. Non-response or side effects with one agent does not mean this will happen with them all so an alternative should be tried.

The NMDA-receptor antagonist memantine is recommended for managing moderate or severe Alzheimer’s disease and for people who cannot tolerate AChEIs. Common adverse effects include constipation, hypotension, confusion, dizziness, headache and tiredness. If tiredness is present, evening dosing could be considered in order to promote sleep.

Other treatments

People with dementia and their families may turn to OTC and herbal supplements to try to prevent and/or delay the onset of dementia. Popular remedies include ginkgo biloba, which increases cerebral blood supply and reduces blood viscosity, but evidence for improvement
is inconsistent.

Non-pharmacological approaches 

Evidence suggests that eating healthily, exercising regularly, being involved in mentally and socially stimulating activities, reducing stress and getting sufficient sleep all reduce the risk of and/or delay the onset of dementia. 

Educational programmes for family members and care organisations using behavioural interventions have been found to be more effective than most pharmacological treatments in BPSD. These include distraction, reality orientation, occupational activities, reminiscence, sensory stimulation and social interaction, as well as exploring any possible underlying causes such as pain, anxiety, depression, or a recent change or upsetting event.

The management of sundowning can be achieved by minimising sleeping during the day to increase sleep at night, taking regular exercise and establishing a day and night routine. Use of bright light therapy in the morning may also reduce the incidence of agitation in the evening. 

Dementia prevention is now a public health issue which all healthcare professionals need to be aware of to best support their patients and local community.

Reflective exercise

Would you be able to signpost people with dementia and their families to support that is local to you? The Alzheimer’s Society and Dementia Action Alliance are useful starting points.