Progressive memory loss and cognitive decline: Exploring causes, management strategies, and prognosis
Advanced dementia, a severe form of the disease that typically occurs during the later stages, requires a comprehensive approach to treatment. This approach encompasses both pharmacological and non-pharmacological methods, each designed to slow disease progression, manage symptoms, and improve the quality of life for those affected.
Pharmacological Treatments
Cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, are often continued into later stages of Alzheimer's disease. These drugs may slow symptom progression, including cognitive decline and difficulties with everyday activities. Another medication, memantine, an NMDA receptor antagonist, is recommended for moderate to severe Alzheimer's, especially when cholinesterase inhibitors are not well-tolerated. Combining memantine and cholinesterase inhibitors is sometimes practiced if monotherapy is insufficient, but this is not always recommended due to potential side effects.
Newer disease-modifying drugs like donanemab show promise in slowing Alzheimer's progression by targeting amyloid protein, though their use is mostly early-stage and less common in advanced dementia.
Non-Pharmacological Treatments
Non-pharmacological treatments focus on supporting quality of life and managing symptoms. Activities that support cognition and emotional well-being are important, such as nostalgic activity-based therapy (e.g., looking at photos) and structured daily routines. Environmental adaptations, personalized care approaches, and support for daily living tasks are crucial in advanced stages to address functional decline and agitation. Behavioral and psychological symptoms may be managed cautiously with non-drug methods first, as medications for behavioral symptoms can increase risks of confusion and falls.
The Role of Advance Care Planning
Advance care planning (ACP) allows people with dementia to record their decisions about treatment, future support, and end-of-life care. Having these conversations early, while the person with dementia can make shared decisions, is essential. ACP may improve end-of-life care for people with dementia and is associated with lower numbers of hospitalizations.
Support for Caregivers and Patients
Organizations such as the Alzheimer's Association provide support to people with advanced dementia and their caregivers. Most people with advanced dementia will need additional care, including institutional care, to manage symptoms. Caregivers should offer support by creating a clear routine, communicating well, and assisting with sensitive care such as personal hygiene.
In advanced dementia, an individual may experience symptoms that affect other parts of the body. Targeting the senses may bring comfort and help reduce agitation. Long-term palliative or hospice care is often needed for people with advanced dementia.
Symptoms of advanced dementia may include severe forgetfulness, increased need for help with personal hygiene, reduced mobility, inability to speak, breathlessness, pain, increased health complications, difficulty swallowing, psychiatric symptoms such as agitation and lack of interest. ACP helps caregivers stick to a person's wishes when the symptoms progress and the person becomes less able to communicate and make decisions.
Balancing Benefits and Side-Effects
It's important to note that the benefits of medication in advanced dementia may be limited and need regular review to balance effect and side-effects. Non-drug approaches remain central to care in later stages. Doctors may consider prescribing antipsychotic medications to treat behavioral and psychological symptoms of dementia (BPSD), but these medications can carry a risk of severe side effects in older adults.
In cases of advanced dementia, doctors may be able to ease symptoms with medication. For example, a combination of donepezil and memantine (Namzaric) is used to treat moderate to severe dementia, and memantine (Namenda) is a medication used for moderate to severe dementia to treat cognitive symptoms and improve a person's ability to perform simple tasks.
Non-pharmacological treatment options for BPSD may include physical exercise, art therapy, and cognitive therapy. Targeting the senses may also bring comfort and help reduce agitation.
Life Expectancy and Complications
The average survival time after a dementia diagnosis is 4-5 years. Advanced dementia can lead to complications such as pneumonia, which can be life threatening. Cholinesterase inhibitors, such as donepezil and rivastigmine, may not be beneficial in all cases of advanced dementia.
In conclusion, treating advanced dementia requires a multimodal approach, combining pharmacological and non-pharmacological methods. While medication can provide some relief, non-drug approaches remain central to care in later stages. Support for caregivers and patients, through organizations like the Alzheimer's Association, is also crucial.
- In the later stages of Alzheimer's disease, cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine are often continued to slow symptom progression, including cognitive decline and difficulties with everyday activities.
- Some individuals with moderate to severe Alzheimer's may benefit from memantine, an NMDA receptor antagonist, especially when cholinesterase inhibitors are not well-tolerated.
- As people age and may be diagnosed with dementia, mental-health conditions such as depression and anxiety may also be present, necessitating holistic health-and-wellness considerations that include both pharmacological and non-pharmacological treatments.
- Supportive non-pharmacological treatments for dementia, like nostalgic activity-based therapy and structured daily routines, are particularly important in the advanced stages to promote cognitive and emotional well-being.
- Advanced dementia can lead to a variety of medical-conditions, including increased health complications, difficulty swallowing, psychiatric symptoms such as agitation and lack of interest. In such cases, advance care planning (ACP) ensures that caregivers can follow a person's wishes as they become less able to communicate and make decisions.
