Introduction.

Over the past 18 months, Engage Estero has published several articles on dementia. The focus is on this condition because it often affects people aged 65 and older, and we believe it is essential for everyone to have a better understanding of it.

As of 2025, approximately 7.2 million Americans aged 65 and older are living with Alzheimer’s disease, which accounts for about 11% of that age group—roughly 1 in 9 individuals. Various authoritative sources indicate that around 10–11% of Americans over 65 are affected by Alzheimer’s. A 2022 brain health study published in JAMA Neurology reported that 1 in 10 Americans over 65—about 10%—have dementia, and an additional 22% experience mild cognitive impairment (MCI). Alzheimer’s is the most common form of dementia.

Our earlier articles on this topic can be viewed on our website and are as follows:

• Understanding and Coping with Dementia.
  • https://esterotoday.com/dementia/
• Determining Whether Forgetfulness is simply a matter of Aging or whether it is the Onset of Dementia.
  • https://esterotoday.com/forgetfulness-aging-or-dementia/
• How to Handle a Family Member with Dementia (Part 1 & Part 2).
  • https://esterotoday.com/how-to-handle-a-family-member-with-dementia-part-1/
  • https://esterotoday.com/continuing-the-journey-through-dementia-care-part-2/

In this article, we take a close look at the treatments available.

Treating Dementia

While there’s no cure for most types of dementia, several treatments can help manage symptoms, improve quality of life, and slow progression in some cases. Regardless of the severity of the disease, it requires a combination of medical, psychological, and social strategies.

Medications

Depending on the type and stage of dementia, certain medications can help manage cognitive symptoms or behavioral issues.

Cognitive Symptom Medications

Used primarily for Alzheimer’s disease, but sometimes in other dementias, the following pharmaceutical products can be used.

These drugs do not stop the disease from progressing, but they can slow its progression and help maintain function for a more extended period.

New Potential Treatments.

Given the market potential for a worthwhile treatment that significantly benefits disease progression, it is no surprise that many pharmaceutical companies have made it a top priority to explore new approaches and compounds to alleviate this condition.

For those readers who are interested in

 some of the primary studies underway, please refer to Appendix 1 of this document.

The developments listed in Appendix 1 reflect a multi-pronged approach to dementia research, encompassing neurobiological mechanisms, accessible therapies, lifestyle interventions, and early diagnostics. While some findings are preclinical or observational, several are moving into trials or clinical use, bringing hope for improved prevention, slowed progression, and even potential reversal in the future.

Medications for Behavioral Symptoms.

The product classes below help to treat agitation, aggression, hallucinations, anxiety, or depression associated with the disease.

• SSRIs (e.g., sertraline, citalopram) – for depression/anxiety
• Antipsychotics (e.g., risperidone) – only for severe aggression or psychosis; used with caution due to stroke risk
• Sleep aids (e.g., melatonin) – for sleep disturbances (avoid sedatives when possible

Non-drug Therapies

Patients and carers need to be aware that these can be just as important — sometimes more — especially in early to mid-stages of dementia.

Cognitive Stimulation Therapy (CST)

These include group activities and exercises designed to improve memory and problem-solving skills and are supported by research for individuals with mild to moderate dementia.

Reminiscence Therapy

This involves the use of photos, music, or objects from the past to stimulate memory and conversation.

Reality Orientation

This helps to reinforce understanding of time, place, and person (e.g., calendars, clocks, signage). It is beneficial in assisting patients to stay connected to their surroundings, time, and identity. It’s particularly aimed at reducing confusion, disorientation, and anxiety by providing consistent and repeated information about the present moment.

Occupational Therapy

This helps maintain independence in daily tasks and reduces the risk of falls, thereby improving safety. This can involve memory games and sequencing puzzles.

Lifestyle and Environmental Support

Routine Structure

Routines for patients help to reduce confusion and anxiety across all stages of the disease. Structured days with planned activities can also help to reduce behavioral symptoms

Nutrition & Hydration

Brain function is affected by malnutrition or dehydration, and soft diets or supplements may be needed in later stages. When a person with dementia isn’t eating well, nutritional supplements can be handy to prevent malnutrition, weight loss, and associated complications like fatigue, muscle loss, and increased confusion. However, supplements should not replace meals if eating is possible — they should support overall nutrition.

If there is muscle wasting or weakness, whey protein powder (can be added to smoothies or puddings), while ready-to-drink protein shakes are also helpful. Vitamins and mineral supplements should also be considered.

Exercise

Regular movement (e.g., walking, light stretching) helps with mood, sleep, and mobility.

Environmental Modifications

Consider label drawers and doors, use night lights, and reduce clutter to avoid confusion.

Support for Severe Dementia

In later stages, the focus shifts from cognitive support to comfort and care. This can include:

• Palliative care for symptom relief and dignity
• Speech therapy for swallowing issues
• Mobility aids and pressure sore prevention
• Pain management — especially if communication is limited
• Music and sensory therapies — soothing even in advanced dementia

Are the treatments for Alzheimer’s Disease and Dementia the same?

It’s common for people to think that treatments for these related conditions and even vascular dementia are the same, but they are not. There’s a notable difference in how Alzheimer’s disease and vascular dementia are treated, although some approaches overlap. The primary difference lies in the underlying causes of each condition.

• Alzheimer’s disease is a neurodegenerative disease caused by the buildup of amyloid plaques and tau tangles in the brain.
• Vascular dementia is caused by reduced blood flow to the brain, usually due to strokes or small vessel disease.

Drug Treatment Approaches in Alzheimer’s and Vascular Dementia

Because of this, the treatment strategies differ in essential ways:

Alzheimer’s Disease (AD)

AD tends to respond to FDA-approved cognitive medications:

Donepezil (Aricept) – all stages

Rivastigmine (Exelon) – mild to moderate

Galantamine (Razadyne) – mild to moderate

Memantine (Namenda) – moderate to severe

Recently, some anti-amyloid drugs (e.g., lecanemab) have been used in early AD in some countries. As mentioned earlier, these medications aim to slow cognitive decline and enhance memory, thinking, and daily functioning.

Vascular Dementia (VaD)

There are no FDA-approved cognitive drugs specifically for VaD.

Sometimes cholinesterase inhibitors (like Donepezil) are used off-label if symptoms overlap with Alzheimer’s — they may help a little, but effects are less consistent.

Primary treatment focus tends to be on managing the underlying vascular problems:

• Blood pressure control
• Cholesterol management
• Blood sugar (diabetes) management
• Preventing further strokes (e.g., with aspirin or other antiplatelet agents)

Prevention of Progression

Alzheimer’s:

The focus is on slowing neurodegeneration. New treatments target amyloid and tau proteins (but their effectiveness is still limited). Lifestyle interventions (exercise, brain stimulation, sleep hygiene) are encouraged but have limited impact on the biological disease process.

Vascular Dementia:

Here, the focus is on preventing further vascular damage: Stroke prevention is key, but so too is the need for aggressive cardiovascular risk management, which can slow or even halt worsening. In some cases, lifestyle changes (such as diet, smoking cessation, and regular exercise) may significantly reduce the risk of further decline.

Vascular dementia may stabilize or even improve slightly if no further strokes occur — something rarely seen in Alzheimer’s.

It should be noted that, when looking at cognitive & behavioral therapies discussed earlier, these apply equally to both conditions.

Advanced Stages

In both types, later-stage care involves:

• Palliative or hospice care
• Speech therapy for swallowing
• Pain and comfort management
• Caregiver support and education

But in vascular dementia, physical symptoms (e.g., weakness, mobility problems) due to strokes may be more prominent and may require additional rehab (e.g., physical or speech therapy).

When It’s Mixed Dementia

Many older adults have mixed dementia — often Alzheimer’s + vascular pathology.

• In those cases, a combination of both treatment strategies is used.
• Alzheimer’s drugs might help, but vascular risk management is still essential.

 Summary and Conclusions

Dementia treatment focuses on slowing progression, managing symptoms, and improving quality of life. While there is no cure, a combination of medications, non-drug therapies, and supportive care can be highly effective in managing the condition.

Effective dementia care requires a holistic, person-centered approach that combines medical, functional, and emotional support tailored to each individual’s unique needs and circumstances. Early intervention, regular monitoring, and a supportive environment can significantly impact maintaining dignity and quality of life throughout the disease course.

Looking toward the future, several new developments showcase a multi-faceted approach to dementia research—from understanding neurobiological mechanisms to creating accessible therapies, promoting lifestyle prevention, and improving early diagnostics. Although some early findings are still preclinical or observational, many hold promise for improved prevention, slowed disease progression, and even potential reversal in the future. Because of the devastating impact of this disease, not only on the individual affected but also on family and friends, we can hold onto hope that ongoing research will lead to success soon.

Appendix 1

New Potential Treatments Undergoing Research for Treating Dementia. Novel Biological Mechanisms & Preclinical Breakthroughs

Lithium orotate in mice

Harvard-led research demonstrated that low-dose lithium reversed Alzheimer’s symptoms in mice by restoring synapses, supporting myelin, and enhancing microglial function to clear debris. It may pave the way for affordable human trials, though human relevance remains unproven.

Shingles (zoster) vaccination and dementia risk

In an extensive observational study, adults aged 71–88 who received the shingles vaccine had a 20% lower risk of developing dementia over seven years—the theory: reduced neural inflammation. Further randomized trials are in progress.

Microglial stress-response targeting in mice

Scientists at City University of New York revealed that blocking stress-induced lipid production in “dark microglia” reversed Alzheimer ‘s-like pathology in mice. This opens potential for novel therapeutic targeting of neuroimmune pathways.

Lifestyle & Prevention Strategies

Mediterranean-style diet

A recent study has shown that this diet may counteract genetic risk factors for Alzheimer’s disease, reinforcing the role of nutrition in preventive strategies.

Lifestyle habits

Brain-healthy practices—like eating blueberries, moderate red wine (due to resveratrol), and regular light exercise—are suggested to support cognitive resilience with age. However, they cannot override genetic predispositions.

Summary: What’s Most Promising?

• Greater accessibility with proven treatments: Home-injectable Leqembi and long-term data from Kisunla® signal progress toward wider, earlier intervention.
• Novel disease-targeting approaches: Lithium orotate, microglial stress inhibitors, and shingles vaccine point to preventive and therapeutic innovation.
• Repurposed and combination strategies: GLP‑1 agonists and senolytics could diversify treatment beyond amyloid-centric models.
• Emerging diagnostics: VR navigation tests, olfactory measures, and neural fingerprinting may enable intervention before severe symptoms arise

Disclaimer

Engage Estero provides information as a service to our readers and is not intending to provide individual medical advice. Always consult with medical professionals or emergency services before changing or initiating medical treatment.. 

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