More often the evaluation of dementia is done by a gerontologist (specialist in geriatrics, the diseases of the elderly), neurologist or psychiatrist. This specialist will identify the underlying disease or what it is not and decide what treatment is best. The gerontologist neurologist or psychiatrist will also monitor treatment over the patient's lifetime.

Treatment of dementia works best in the early stages, least well in the late stages. If an elderly person has problems with memory or thinking, they should have a medical evaluation (work-up) as soon as possible.

The reason is that the treatments available today work best in the early stages of memory loss, or when reasoning problems are still mild. They don't work well, or not at all, when memory loss is severe.

Medications
Some diseases that cause dementia can be treated specifically. If treated early, the dementia may even be cured.

Examples include masked depression (mentioned earlier), which often responds to serotonin-re-uptake inhibitors; and other causes like vitamin B12 deficiency caused from no longer absorbing the vitamin in the intestine ("pernicious anemia"), very low levels of thyroid hormones ("hypothyroidism"), problems clearing out cerebrospinal fluid ("normal pressure hydrocephalus") or from having lots of small strokes ("lacunar infarcts") from long-standing high blood pressure or from inflammation of blood vessels in the brain ("vasculitis"): these last two are both called "multi-infarct dementia."

Some common forms of dementia respond well to any one of a series of "cholinergic" drugs. Those include Alzheimer's disease and multi-infarct dementia. The drugs used include Aricept, Exelon and Reminyl.

Cognex was the first drug of this class: a class which acts on the neurotransmitter chemical, acetylcholine, in the brain. Cognex has to be taken four times a day. It sometimes gives stomach or liver trouble. Most patients nowadays are on the other drugs, but a few respond so well to Cognex they rightly continue on it.

The cholinergic drugs have been shown to slow down the progression of cognitive loss -- memory loss or other problems with reasoning and thinking. In a few patients, there can even be an improvement!

While this is great, the goal of the treatment is really to slow the progression of cognitive loss so that the person can live at home longer than would be the case without treatment.

Cholinergic drugs help reduce behavioral problems that come in the moderate stages of dementia. Wandering at night, certain kinds of hallucinations and aggressive acts can make it hard to care for an elderly person whether at home or in a facility. Often these problems need to be treated with additional medicines.

There are new medications available that can help in most cases without producing side effects. The problem would be treating someone with the "cholinergic" drugs and missing the fact that they have a "curable" or highly treatable dementia instead of Alzheimer's.

Hope and Help for Many
Today, there's help for many with memory and thinking disorders. Accurate diagnosis and prompt treatment can reverse some dementias and slow others.

The benefits are obvious and many. Treatment given early will usually reduce the level and cost of the patient's care -- allowing the patient to live at home or in an assisted living setting instead of a more costly nursing home.