Medical Treatment

There are two kinds of medical treatment: dementia and psychiatric medications. Doctors will prescribe medication based on the severity of the emotional and behavioural problems of patients, form and stage of dementia as well as the physical conditions of patients. The timing and dosage of medical treatment vary from person to person. Doctors will conduct regular follow-up consultations, use the lowest possible effective dosage and suitable course of treatment to reduce the side effects.

Dementia medication can help slow down the progression of symptoms and reduce behavioural disorders. Cholinesterase inhibitors such as Donepezil, Rivastigmine and Galantamine are used in early stage to late stage dementia patients, whereas Memantine tends to be used in middle to late stage patients.
 

Common dementia medications and their comparison

Category Name of medicine Pharmacology Side effects
Category:Cholinesterase inhibitors (ChEls) Name of medicine:Donepezi (Aricept)l Pharmacology:Inhibit the decomposition of cholinesterase in the brain Side effects:Dizziness, diarrohea, vomiting, poor appetite, insomnia, muscle cramps, gastrointestinal upset, asthma, chronic bronchitis, frequent urination, arrhythmia
Category:Cholinesterase inhibitors (ChEls) Name of medicine:Galantamine (Reminyl) Pharmacology:Inhibit the decomposition of cholinesterase in the brain Side effects:Dizziness, diarrohea, vomiting, poor appetite, insomnia, muscle cramps, gastrointestinal upset, asthma, chronic bronchitis, frequent urination, arrhythmia
Category:Cholinesterase inhibitors (ChEls) Name of medicine:Rivastigmine (Exelon) Pharmacology:Inhibit the decomposition of
  • Cholinesterase
  • Butylcholine
In the brain
Side effects:Dizziness, diarrohea, vomiting, poor appetite, insomnia, muscle cramps, gastrointestinal upset, asthma, chronic bronchitis, frequent urination, arrhythmia
Category:Memantine Name of medicine:Memantine (Ebixa) Pharmacology:Avoid over-stimulation of nerve cells through inhibiting glutamate transmission in the brain Side effects:Nervousness, insomnia, diarrohea, headache, illusion, cough, tiredness

Cholinesterase inhibitors are available in oral and patch forms, patch inhibitors allow the drug to get under the skin into the body for more stable absorption. This helps reduce common side effects, such as nausea, vomiting and poor appetite*. Meanwhile, fewer side effects help encourage patients to follow the prescription and allow doctors to adjust the dosage to an optimal level for better control of disease progression. However, patch inhibitors may cause skin irritations such as itching and redness.

Cholinesterase inhibiting patch should be applied once a day. When replacing the patch, caregivers should remove the old patch before applying the new one. They should also apply the patch at different positions every day.

Psychiatric drugs can help control emotional symptoms. Doctors will prescribe sedatives, antidepressants, anxiolytics, etc. based on patients’ symptoms. However, these drugs may affect the cognitive abilities of patients and increase the risk of falling.

After the use of these drugs, caregivers should observe if there is any improvement in the emotional states of patients and any side effects. In case of any side effects or deterioration of emotional problems, caregivers should seek professional help immediately and should never stop the use of prescribed drugs or adjust the dosage themselves.
 
  *Sources:Winblad B, et al. Int J Geriatr Psychiatry. 2007;22:456-467. http://www.mims.com
 
 

More relevant information (Chinese Version Only)




Source:
香港老人科醫學會 - 認知障礙症的情緒行為管理

香港老人科醫學會 - 認識認知障礙症
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Last Update: 28/11/2022