Most types of dementia cannot be cured. The exceptions are:

• those dementias related to vitamin or hormone deficiency, which can be treated with supplements,
• those related to head injury, hydrocephalus or tumour, which may be treatable with surgery,
• those related to medication, which can be treated by altering the medication, and
• those related to infections, where treating the infection will normally cure the dementia.

Medication for Alzheimer's disease

Alzheimer's disease cannot be cured. However, for some people in the early and middle stages of the disease, the medicines donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) may help prevent some symptoms from becoming worse for a period of time. A new medicine called memantine (Ebixa) may have the same effect for some people who have moderate or severe Alzheimer's disease.

How do they work?

Aricept, Exelon and Reminyl all work in a similar way and are known as acetylcholinesterase inhibitors.

Research has shown that there is not enough of a chemical called acetylcholine in the brains of people with Alzheimer's disease. Acetylcholine is one of the chemicals that nerve cells use to communicate.

Aricept, Exelon and Reminyl prevent an enzyme from breaking down acetylcholine in the brain. Increased concentrations of acetylcholine lead to increased communication between nerve cells, which may in turn temporarily improve or stabilise the symptoms of Alzheimer's disease.

Aricept, Exelon and Reminyl are only used in people with mild to moderate Alzheimer's disease. They are not effective for everyone and may only temporarily improve memory or delay memory loss.

Revised guidance by the National Institute for Health and Clinical Excellence (NICE) recommends that:

• Anticholinesterase drugs are given to people in the moderate stages of Alzheimer’s disease.
• People with Lewy-body dementia may be offered an acetylocholinesterase inhibitor if they find that their non-cognitive symptoms are very distressing.

NICE has also recommended that Aricept, Exelon and Reminyl should be available on NHS prescription for anyone with a diagnosis of Alzheimer's disease who could benefit from the drug treatment. See our page on NICE guidance for more information

Ebixa can temporarily slow down the progression of symptoms in people in the middle and later stages of the disease. There is also a suggestion that Ebixa may slow down the disease process itself.

Medical researchers are currently investigating other medical treatments, including antioxidants, brain stem cell therapy and a vaccination to stop the build-up of plaques in the brain (a hallmark of Alzheimer's disease).

What are the side effects?

Not everyone has the same side effects or has them for the same length of time, if they have them at all. The most frequent side effects of Aricept, Exelon and Reminyl include:

• nausea and vomiting,
• diarrhoea,
• stomach cramps and headaches,
• dizziness,
• fatigue,
• insomnia and
• loss of appetite.

Side effects of Ebixa include hallucinations, confusion, dizziness, headaches and tiredness.

Importance of mental activity

It is thought that mental activity can help to slow the progress of some types of dementia, so you should encourage someone with dementia to stay mentally and physically active and ensure their environment is stimulating.
Puzzles, games (particularly memory games), reading and simple mental arithmetic are good choices, but it's important not to overwhelm them with too many demands, or unrealistic demands, as this may only frustrate them.

A technique called reality orientation may help some people with dementia. It uses repetition to help the memory and involves regularly reminding the person of information such as the time, date, where they are and important information for that day, such as a visit to see a friend.

The information could be given verbally by a carer, or be written on a board in their home where they will see it regularly. The aim of reality orientation is to help people understand their situation by reminding them or telling them about what's going on.

Care and support

Many of those with dementia in the early and intermediate stages are able to cope well in their own home, due to the familiar surroundings. Others may need more frequent supervision, full-time care in the home, or care in a residential or nursing home.

Support and care is the most important part of treatment for dementia. Many people with dementia are cared for in the community, often by a relative or friend.

However, caring for a person with dementia can be very difficult. Support and advice for those caring for someone with dementia is available from the following sources:

• district nurses, who can advise on day-to-day nursing care,
• community psychiatric nurses, who can advise on caring for someone with a mental illness,
• social services, who can help with care in the home, day-care centres, respite care and benefits,
• voluntary organisations - in most areas of the UK there are organisations that provide support and advice for carers of people with dementia.