Dementia in Amyotrophic Lateral Sclerosis (ALS)
Treatment for Dementia in ALS
Treatment of dementia in ALS and other motor neuron diseases focuses on relieving symptoms.
Drugs for Dementia and ALS
No specific drug treatment is available for frontal lobe dementia in motor neuron diseases like ALS.
- The few available treatments for motor neuron diseases have had little effect on the dementia. Riluzole (Rilutek) is currently the only approved medication for motor neuron diseases. No strong evidence shows that this drug improves dementia due to motor neuron disease.
- Another drug widely used to treat motor neuron disease, gabapentin (Neurontin), has shown no positive effects on dementia.
- Drugs called cholinesterase inhibitors used in Alzheimer's disease (another type of dementia) may worsen irritability in people with frontal lobe dementia. These include donepezil (Aricept), rivastigmine (Exelon), and galantamine/galanthamine (Reminyl).
Behavior disturbances may improve with medications that include:
- Antidepressants that alter brain chemistry in certain ways can improve mood and/or calm agitation. These include the selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine(Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).
Antipsychotic medications such as dopamine blockers, which are also used to treat psychosis; these include olanzapine(Zyprexa).
Next Steps for Demential and ALS
People with fronto-temporal dementia-like symptoms require regularly scheduled follow-up visits with the medical professional coordinating his or her care. These visits will give the coordinator a chance to check progress and monitor behavioral changes. The coordinator can make recommendations for changes in treatment if any are necessary.
Prevention of Dementia and ALS
There is no known way to prevent ALS or the dementia that may be seen with it. This is an area of intense research in motor neuron diseases.
Outlook for Dementia and ALS
No cure is available for fronto-temporal lobe dementia or ALS, the underlying motor neuron disease. Motor neuron diseases are terminal illnesses, meaning that they cause death. Most people with motor neuron disease die within five years of the first symptoms. The actual cause of death is usually respiratory failure or infections related to respiratory disability.
Motor neuron disease linked to dementia seems to be even more aggressive. People with this form of the disease usually die within three years of the first symptoms.
If you have motor neuron disease, you should take the opportunity to express your wishes about medical care, estate planning, and personal issues while you are still able.
- Preferences concerning medical care at the end of life should be clarified early and documented in your medical chart. Your spouse and other close family members should understand your wishes. Early clarification of these wishes prevents conflicts later when you are not able to speak for yourself.
- You should consult a lawyer as early as possible. Personal affairs should be settled. Later in the disease, you may not be able to sign papers or even communicate your wishes.