How common is memory loss?
The term used for age related memory loss is dementia. The number of cases of dementia is expected to increase from 245,400 in 2009 to 1.13 million cases by 2050 in Australia.
Dementia is estimated to be present in:
- 5% in persons greater than 65 years old
- 20% in persons greater than 80 years
- 30% of persons greater than 90 years old.
Is there a cure for Dementia?
There is currently no cure for old age memory loss. While everyone gets a bit more forgetful as we get older, dementia is different. It is not a ‘normal’ part of ageing. Moreover, different diseases can cause dementia. Hence it is unlikely that there will be a single cure for dementia.
Researchers around the world are trying to find cures for dementia-causing diseases, such as Alzheimers disease and Vascular dementia.
What is the treatment for dementia?
A multifactorial tailored management of AD has the following components:
- Open communication, accurate evaluation and diagnosis, and suitable Advice.
- Behavioural approaches:
- - Consistency of care and simplification of environment
- - Establish routines
- - Calm interactions, providing pleasurable activities
- - Timely planning for legal and medical decisions and needs
- - Cognitive behavioural therapyfor anxiety and depression.
- - Exercise and music therapy.
- Caregiver support:
- - Respite care
- - Psychoeducation
- – Care giver support
- Pharmacological interventions (medicines for dementia)
Is there a medicine to treatment memory loss?
Dementia is a progressive illness that means the memory lost due to dementia is unlikely to come back. This is because of the progressive destruction of nerve cells that carry information and memory due to the disease process. For instance, the pathological processes in Alzheimer’s disease (AD) are the deposition of amyloid plaques outside the nerve cells and the formation of Tau neurofibrillary tangles (NFTs) inside the neurons. Hence the medicines called disease-modifying treatments (DMT) are designed to target them. However, such treatments have not had enough success to be recommended for routine treatment of Dementia. The medicines for Dementia available in the market currently are aimed at improving the cognitive function or reducing the behavioural and psychological symptoms associated with dementia (BPSD).
Drugs that stabilise cognition in dementia
Acetylocholinesterase inhibitors (AChEIs) eg: Donepezil, Rivastigmine attempt at reducing the breakdown of acetylcholine levels in the brain of the patients with AD by inhibiting the breakdown of the same. When given in moderate to severe dementia, they tend to mitigate decline in cognition at least during the first year of treatment. These benefits are temporary and are usually offset by the side effects such as diarrhoea, nausea, irregular heartbeat, dizziness etc. The duration of treatment is usually 6months to 2 years.
Drugs that treat behavioural and psychological symptoms associated with dementia (BPSD) in Dementia?
Antipsychotics and antidepressants remain the main medications for BPSD. Selective serotonin reuptake inhibitors such as Sertraline and Escitalopram are preferred for treating depression and anxiety. Antipsychotics should be administered only when a significant safety risk for the patient or for the caregivers by aggressive behaviours makes them necessary. Promising new agents are coming up. Lumateperone is one such drug; it is a first-in-class selective and simultaneous modulator of serotonin, dopamine and glutamate, which is under clinical development for behavioral disorders associated with dementia. Evidence does not adequately support the use of benzodiazepines, anticonvulsants or stimulants but may be used in some cases. Pharmacological approaches to managing BPSD are highly tailored and changeable, depending on patient’s comorbidities, stage of the disease, and symptoms’ severity.
How to prevent progression to Dementia?
Old age memory loss or the risk of cognitive decline can be modified or prevented by the following strategies:
- Regular physical activity
- Management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension)
- Healthy diet
- Lifelong learning/cognitive training
It is estimated that modifying such factors in midlife can reduce the risk of development of dementia in later life by up to 30%.
Are there any newer drugs for Dementia?
Huge strides have been made in understanding how different diseases cause damage in the brain and so produce dementia. For instance, the pathological processes in Alzheimer’s disease (AD) are the deposition of amyloid plaques outside the nerve cells and the formation of Tau neurofibrillary tangles (NFTs) inside the neurons.
- Disease modifying treatments (DMT) targeting Amyloid:
Umibecestat is a beta secretase inhibitor, which helps to reduce the formation of amyloid it is in Phase 3 clinical trials. CAD106 is used as an active immunotherapeutic agent to increase the removal of deposited amyloid currently in preclinical trials. Aducanumab is a passive immunotherapeutic agent that can also assist in removal of the amyloid and is showing promising results in clinical trials so far.
- Disease modifying treatments (DMT) targeting Tau protein:
Lithium Chloride helps prevent the formation of Tau tangles whereas Nilotinib improve the clearance of Tau.
- Neuro-protective agents- Levetiracetam
- Anti-inflammatory agents- Cromolyn plus Ibuprofen and Elderberry juice.
- Stem-cell therapies- Astrostem and Human mesenchymal stem cell therapy.
A review on this topic was published in March 2020 titled pharmacological prevention of cognitive decline and dementia. The author, Jessen F conducted a literature review of epidemiological evidence and clinical trials of the following:
- Anti-dementia drugs
- Anti-amyloid drugs under development
- Nonsteroidal anti-inflammatory drugs
- Hormone replacement therapy
- Ginkgo biloba
- Fortasyn Connect (Medical food).
They concluded that there is no sufficient evidence yet to provide any recommendation for drug- or compound-related prevention of memory loss or dementia. Hence we have to wait for a bit longer before we have a cure for dementia or a cure for memory loss.
Where to find memory loss treatment in Melbourne?
If you are suspecting dementia in your loved ones, the first step is to see your family doctor. Your GP can screen their symptoms and write a referral to a specialist doctor. The specialist doctor could be a general psychiatrist, a dementia psychiatrist (otherwise called an old age psychiatrist or a psycho-geriatrician), a geriatrician or a neurologist. Although, any of these specialists can help, psychiatrists in dementia care can look into both the brain and behavioural aspects of their presentation. Some individuals are likely to feel stigmatised about seeing a psychiatrist for memory loss, but if you are looking at holistic assessment and treatment suggestions, it is better to consult a dementia psychiatrist. Psychiatrists for Dementia in Melbourne will diagnose dementia after taking a full medical history, conducting tests of your memory, thinking, mood and behaviour, ordering blood tests and finally getting a brain scan. Dementia and memory clinics are set up in public and private hospitals and clinics. A private dementia psychiatrist in Melbourne such as the one available at Mindoc psychiatry clinic, Melbourne will be able to conduct a clinical assessment and offer treatment recommendations. Treatment of Dementia in Melbourne by a psychiatrist often involves liaising with multiple agencies and providers to co-ordinate care. They may also assist with hospitalisation or provision of ECT if required.
If you need further information, please don’t hesitate to call us or book an appointment online.
Yiannopoulou, K. G., & Papageorgiou, S. G. (2020). Current and Future Treatments in Alzheimer Disease: An Update. Journal of central nervous system disease.