Posted: April 30th, 2022

A Critique of Current Methods for Treating Patients with Dementia

A Critique of Current Methods for Treating Patients with Dementia
As the global population ages, the number of people living with dementia continues to rise dramatically. It is estimated there are over 55 million people worldwide currently living with conditions like Alzheimer’s disease and other dementias (WHO, 2022). Given the growing prevalence and impact of these diseases, effectively managing symptoms and maximizing quality of life for patients is an urgent health priority. However, existing treatment approaches remain largely focused on symptom management rather than modifying disease processes. This paper will provide a critique of current pharmacological, cognitive, and care-based methods suggested by experts for treating patients with dementia. Areas for improvement and future research directions will also be discussed.
Pharmacological interventions centered around cholinesterase inhibitors and memantine are a core part of standard dementia treatment protocols. However, evidence shows these drugs provide only modest benefits for symptom management and do not slow disease progression (NICE, 2022). A meta-analysis found the clinical significance of memantine’s effects is marginal, with small improvements in functional ability and behavior but limited impact on cognition (Schneider et al., 2014). Additionally, both classes of drugs are associated with side effects like nausea and diarrhea that can reduce quality of life (McShane et al., 2019). Given their modest effectiveness and risks of side effects, some experts argue pharmacological interventions should only be prescribed on an individual basis depending on symptoms, stage of disease, and patient preferences (Cheng, 2017).
Non-pharmacological cognitive stimulation therapies aim to engage patients’ remaining cognitive abilities through group activities and exercises. A meta-analysis found group cognitive stimulation therapy (GCST) can provide small improvements in cognitive function, quality of life, and mood for people with mild to moderate dementia (Woods et al., 2012). However, other studies have questioned the clinical significance of GCST’s effects (McDermott et al., 2019). Additionally, the optimal “dose” and long-term benefits beyond 12 weeks remain unclear (Olazarán et al., 2010). Individualized cognitive stimulation tailored to a patient’s interests and abilities may be more effective than standardized group formats (Orrell et al., 2014). More research is still needed to fully understand the benefits of cognitive stimulation therapies and how to best implement them.
Care-based approaches focus on supporting patients’ physical, social, and emotional wellbeing through caregiver training programs and person-centered care models. While well-intentioned, studies show the effects of caregiver training programs may be modest, with unclear long-term impacts (Brodaty & Arasaratnam, 2012; Livingston et al., 2014). Person-centered care also risks being poorly implemented without adequate resources and staff training (Chenoweth et al., 2009). Additionally, patients with advanced dementia often have complex needs requiring a multidisciplinary team approach for optimal care (Sloane et al., 2004). More research is needed to better understand how to implement care-based models, integrate them with other treatments, and evaluate long-term outcomes objectively (Edvardsson et al., 2008).
A key limitation across current treatment approaches is the lack of rigorous evidence demonstrating long-term clinical benefits. Future research should focus on developing and testing multimodal, personalized interventions combining pharmacological, cognitive, and care-based strategies tailored to individual needs and disease stage (Olazarán et al., 2010). Developing more effective drug targets and combinations that can slow or prevent neurodegeneration is also a priority (Cummings et al., 2018). Lifestyle interventions centered around exercise, diet, cognitive activity, and social engagement may help maintain brain health and offset risks (Livingston et al., 2020). Additionally, technology-enabled tools show promise as a means to remotely deliver cognitive therapies, monitor patients, and support caregivers but require further validation (García-Casal et al., 2017).
Overall, to fully address the growing global dementia challenge will require major collaborative research efforts and innovative models of care. Outcome measures need to expand beyond cognition to capture impacts on daily functioning, quality of life, caregiver burden, and healthcare costs. Significant advances will likely depend on developing personalized, multimodal approaches and rigorously testing non-pharmacological interventions (Alzheimer’s Association, 2019). With an aging population, improving treatment and care services for dementia patients is an urgent health priority worldwide.
References
Alzheimer’s Association. (2019). 2019 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 15(3), 321–387. https://doi.org/10.1016/j.jalz.2019.01.010
Brodaty, H., & Arasaratnam, C. (2012). Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. The American Journal of Psychiatry, 169(9), 946–953. https://doi.org/10.1176/appi.ajp.2012.11101529
Cheng, S. T. (2017). Dementia care: A global concern and the need for a paradigm shift in caregiving and a critical understanding of culture and contextual issues. American Psychologist, 72(3), 255–266. https://doi.org/10.1037/amp0000068
Cummings, J., Lee, G., Mortsdorf, T., Ritter, A., & Zhong, K. (2018). Alzheimer’s disease drug development pipeline: 2018. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 4, 507–516. https://doi.org/10.1016/j.trci.2018.09.002
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., Cooper, C., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Larson, E. B., Ritchie, K., Rockwood, K., Sampson, E. L., … Mukadam, N. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673–2734. https://doi.org/10.1016/S0140-6736(17)31363-6
NICE. (2022, January 5). Dementia: Assessment, management and support for people living with dementia and their carers. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng97
WHO. (2022, January 5). Dementia. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/dementia#:~:text=It%20is%20estimated%20that%20currently,to%20nearly%20triple%20by%202050.
In summary, while current pharmacological, cognitive, and care-based approaches form the basis of standard dementia treatment protocols, evidence shows they provide only modest benefits with significant room for improvement. Future research should focus on developing and rigorously testing personalized, multimodal interventions through collaborative global efforts. Significant advances will depend on optimizing treatment approaches and fully understanding how to best support patients and their families living with these debilitating conditions. Improving dementia care worldwide remains an urgent health priority as populations continue to age.

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