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Diagnosis and Treatment
Patients diagnosed with Alzheimer's disease are likely to be prescribed:
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne, previously labeled Reminyl)
- Memantine HCL (Namenda)
These medications may also be used with other patients who do not show clear evidence of Alzheimer's disease but have cognitive difficulties. Patients thought to have vascular dementia or cognitive difficulties secondary to stroke benefit from controlling risk factors for additional strokes. The risk of stroke may be reduced with medications to help control hypertension, reduce high cholesterol, control diabetes, weight loss, and smoking cessation. Patients with dementia and cognitive impairment may develop problems with depression, anxiety, impulsivity, sleep disorders, and other behavioral problems that may respond to many different medications. Some medications prescribed for other health problems may also make cognitive difficulties more pronounced. We can help patients and their families communicate with other healthcare professionals about recommended treatments and potential problems and complications related to these medications.
Patients and their families benefit from gaining a better understanding of the patient's limitations, prognosis and preserved abilities. After completing neuropsychological testing, patients and interested family members are offered a feedback session in which the patient's strengths and weaknesses are reviewed. Information is provided regarding coping with and compensating for these limitations. Patients and their families are offered psychotherapy sessions, if appropriate, to help in coping with their diagnosis, life changes necessitated by these diagnoses, and behavioral changes secondary to these types of disorders. Patients and their families are encouraged to talk about such things as end-of-life issues and safety issues for the patient and those around him.
Increasing physical and mental activity, smoking cessation, weight loss, stress management, utilizing memory strategies, and other behavioral strategies frequently can be helpful to patients with cognitive impairment. Our patients are provided with education about behavioral changes that may be of benefit to them and offered assistance in achieving these goals. Although a healthy diet is likely to be important, to date there is no compelling evidence that any specific dietary supplements are effective in the treatment of dementia or in enhancing cognitive abilities.