'Am I losing my marbles Doc?'

Treatment of dementia depends on the type of dementia involved.

Comprehensive management involves symptom treatment (usually with cognitive enhancing medication and psychotropic drugs), education and support for patient and carer/family, and cognitive enhancement programs.

Symptomatic treatment for Alzheimer's disease is available in the form of cholinesterase inhibitors (donepezil tablets, galantamine capsules, and rivastigmine patches) and the glutamate NMDA receptor antagonist memantine.

These medications can improve cognitive function (particularly attention and memory) and improve behavioral disturbances (such as apathy, psychosis, agitation, depression and anxiety), and maintain function over the longer term. If a patient shows benefit the medication should be continued. Dose increases may be needed.

Although only approved for subsidy under the Pharmaceutical Benefits Scheme (PBS) for Alzheimer's disease, these medications can help in other dementia conditions that have overlapping neuropathology with Alzheimer's disease (Lewy body dementia, vascular cognitive impairment). Specialist consultation (physician, geriatrician, or psychiatrist) is required to gain access to PBS authority support for these medications.

Unfortunately, no disease modifying agents are available for the common dementia conditions at the moment. Much research is underway in this area.

In the future it is possible that with early detection of individuals at risk of dementia the application of disease modifying (or "curative') interventions will prevent dementia onset. Then no longer will patients have to ask if they are "losing their marbles"!