Comprehensive Analysis of Dementia Treatment Methods

The treatment of dementia currently still focuses on the core objectives of “symptom relief, functional maintenance, and improvement of quality of life.” Since the disease course is irreversible, treatment strategies emphasize the combination of pharmacological and non-pharmacological interventions, together with multidisciplinary care.

I. Pharmacological Treatment

Pharmacological treatment is at present the most commonly used clinical approach, mainly targeting Alzheimer’s disease and certain other types of dementia. Although medications cannot cure the disease, they can improve symptoms to some extent, slow disease progression, and reduce caregiving burden.

1. Acetylcholinesterase Inhibitors (AChEIs)

• • Representative drugs: Donepezil, Rivastigmine, Galantamine.
  • Mechanism of action: Inhibit the breakdown of acetylcholine, enhance neural transmission efficiency, and strengthen synaptic signaling.
  • Clinical application: Suitable for mild to moderate Alzheimer’s disease; also effective in some cases of Lewy body dementia.
  • Clinical significance: Can improve memory, attention, and daily functioning, and delay disease deterioration.
  • Monitoring of side effects: Attention must be paid to adverse reactions such as nausea, vomiting, loss of appetite, and arrhythmia; regular clinical follow-up is required.

2. NMDA Receptor Antagonists

• • Representative drug: Memantine.
  • Mechanism of action: Block neurotoxicity caused by excessive glutamate, thereby slowing neuronal death.
  • Clinical application: Used in moderate to severe Alzheimer’s disease, often in combination with AChEIs.
  • Clinical significance: Improves cognitive and behavioral symptoms, reduces caregiving burden, and enhances patient quality of life.
  • Monitoring of side effects: Possible adverse effects include dizziness, constipation, and blood pressure fluctuations, requiring clinical observation.

3. Monoclonal Antibody Therapies

• • Representative drugs: Lecanemab, Donanemab.
  • Mechanism of action: Target β-amyloid plaques to promote clearance and reduce pathological deposition.
  • Clinical application: For patients with early-stage Alzheimer’s disease; requires MRI monitoring for cerebral edema or hemorrhage.
  • Clinical significance: Slows disease progression, representing a new direction in treatment; however, costs are high and long-term safety still requires evaluation.
  • Limitations: Applicable only to specific patients, with strict monitoring of side effects necessary.

4. Other Medications

• • Antipsychotics: Short-term, low-dose use for hallucinations or aggressive behavior, but must be used cautiously to avoid adverse effects.
  • Antidepressants: Used to improve accompanying depressive or anxiety symptoms, enhancing emotional stability.
  • Clinical significance: Although not targeting the core disease process, these medications can improve patient quality of life and the caregiving environment at home.

II. Non-Pharmacological Treatment

Non-pharmacological treatment plays an important role in dementia care, emphasizing functional maintenance, emotional support, and improvement of quality of life. Although its effects are not as direct as medication, it can exert sustained influence in long-term care.

1. Cognitive Training

• • Method: Through activities such as word games, number exercises, and simple problem-solving, memory and language abilities are stimulated.
  • Clinical significance: Suitable for patients with mild to moderate dementia, can enhance social interaction and reduce feelings of isolation.

2. Reminiscence Therapy and Life Story Work

• • Method: Use photographs, music, and old objects to evoke memories, encouraging patients to share past experiences.
  • Clinical evidence: Can improve mood, strengthen self-identity, and reduce anxiety and depression.
  • Clinical significance: Suitable for patients with moderate dementia, can maintain emotional connections and enhance family support.

3. Environmental and Daily Life Adjustments

• • Method: Establish fixed routines, simplify tasks, and provide a safe environment.
  • Clinical application: For example, setting clear signs at home and reducing complicated items to lower confusion.
  • Clinical significance: Reduces risk of falls, lowers anxiety, and enhances sense of safety in daily life.

4. Lifestyle Changes

• • Regular exercise: Multiple randomized controlled trials show that aerobic exercise (walking, swimming, tai chi) can improve cognitive test scores and slow disease progression. Exercise promotes cerebral blood flow, increases brain-derived neurotrophic factor (BDNF), improves neuroplasticity, while also reducing cardiovascular disease risk, improving sleep and mood.
  • Healthy diet: Rich in fruits, vegetables, whole grains, fish, and olive oil, low in salt and fat, can control blood pressure, improve metabolic status, reduce risks of diabetes and obesity, and indirectly decrease dementia occurrence.
  • Smoking cessation and reduction of alcohol: Quitting smoking and controlling alcohol intake can reduce cerebrovascular lesions and neurotoxicity.

5. Mental Health and Social Interaction

• • Through psychological therapy, community activities, and family support, feelings of isolation can be reduced, mood improved, and cognitive function maintained.

6. Hearing and Vision Correction

• • The use of hearing aids and vision correction can significantly reduce dementia risk, improve sensory input, promote social participation, and reduce cognitive decline.