Interventions for cognitive symptoms in dementia

nterventions for cognitive symptoms

Non pharmacological intervention

• "structured group cognitive stimulation therapy" have been shown to be beneficial for people with mild to moderate dementia. Cognitive stimulation include:
  • exposure to and engagement of activities and materials involving some degree of cognitive processing which are usually within a social context (1)
  • often these are group based, with the importance on enjoyment of activities (1)
  • activities include
    • a programme of memory provoking, problem solving and conversational activities
    • the space retrieval method
    • face name training (2)
  • should be considered irrespective of drug treatment (1)
  • can be done at home by a caregiver and requires minimal training or education of the care giver (2)
• reality orientation therapy (ROT) is a psychosocial intervention used on an individualised basis and has proven to be useful for people who are disoriented in time, place and person (2)

Pharmacological therapy

Pharmacological treatment of Alzheimer's disease is described in the linked item.

Pharmacological management of non-Alzheimer's dementia

• donepezil or rivastigmine should be offered to people with mild to moderate dementia with Lewy bodies
  
  
• only consider galantamine for people with mild to moderate dementia with Lewy bodies if donepezil and rivastigmine are not tolerated
  
  
• donepezil or rivastigmine should be considered for people with severe dementia with Lewy bodies
  
  
• consider memantine for people with dementia with Lewy bodies if AChE inhibitors are not tolerated or are contraindicated
  
  
• only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer's disease, Parkinson's disease dementia or dementia with Lewy bodies
  
  
• do not offer AChE inhibitors or memantine to people with frontotemporal dementia
  
  
• do not offer AChE inhibitors or memantine to people with cognitive impairment caused by multiple sclerosis

Reference:

• 1. National Collaborating center for mental health 2007: Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care
• 2. Scottish Intercollegiate Guidelines Network 2006. Management of patients with dementia: A national clinical guideline
• 3. NICE (June 2018). Dementia: assessment, management and support for people living with dementia and their carers