Like schizophrenia, dementias are chronic and usually worsen, with low function. While in schizophrenia moderate symptom improvement can be achieved with antipsychotic medications, minimal symptom improvement can be achieved for memory loss in dementias. At this time, dementia cannot be cured, and treatment is minimally helpful for cognitive symptoms. (As a related matter, antipsychotics can help with agitation and psychosis that can occur with dementia).
About two decades of many expensive studies have shown that our current best neuroscience fails to lead to effective treatment. For instance, the apo-E-4 gene is associated with Alzheimer’s dementia in about 10% of persons with that disease, yet drugs which target that gene and its products have proven ineffective repeatedly.
The future probably lies with prevention, perhaps with overlooked agents like lithium. For now, the best treatment of dementia is to do what is possible to decrease risk factors for dementia.
Currently marketed medications for dementia treatment increase acetylcholine in the brain, but they have minimal benefit.
Dementia is not one disease; rather there are dementias of many causes. The most common is Alzheimer’s dementia, which is mainly genetic. It is followed by “vascular” dementia, which typically has abnormalities in the white matter of the brain, and is caused by hypertension; since hypertension is treatable, this type of dementia should be preventable in part. Another type of dementia occurs in chronic traumatic encephalopathy (CTE), which occurs after repeated concussions, usually in athletes; this condition is also preventable. Other dementias are caused by separate diseases: Lewy Body dementia happens in Parkinson’s disease; frontal lobe dementia (Pick’s disease) can be caused by brain tumors.