Is dementia reversible?

The medical field has invested time and energy into the question of whether dementia, a general term for memory and thinking problems, can be treated and cured. 

Dementia, in all its various forms, affects more than 55 million people worldwide. It is one of the major causes of disability in older adults, and is the seventh leading cause of death globally, according to the World Health Organization.

So, the question remains, is dementia reversible? The short answer is no. While dementia is treatable, and some conditions causing dementia may be reversible, it is not possible to reverse dementia itself.

Dementia overview 

There is a common misconception that dementia is a normal part of aging. Although it is more common as people grow older, with Alzheimer’s disease affecting 5–10% of people over 65 years old and 50% of people over 85 years old, the brain impairments associated with dementia are not a normal part of aging.

Dementia happens when nerve cells in the brain stop working as they should. This can be due to various reasons, including rare genetic variants or neurodegenerative disorders.

With Alzheimer’s disease, the most common form of dementia, proteins called amyloid plaques and tau tangles build up in the brain, causing adverse changes.

With vascular dementia, the blood vessels in the brain become damaged and the flow of blood and oxygen in the brain is interrupted.

Symptoms range in severity from mild to severe. In the mild stage, a person is able to function but with poor judgment and confusion. In the most severe stages, a person depends completely on others for everyday activities, such as bathing and feeding. 

Dementia also affects language, from losing words to using unusual words to refer to familiar objects to a complete loss of language in the most severe phases.  

Is it reversible?

While dementia is not fully reversible, an older review study from 2009 suggests that there might be some reversible conditions or causes identified in patients with dementia, and research into this is ongoing.

These conditions include:

• depression
• drug or alcohol misuse
• space-occupying lesions
• normal pressure hydrocephalus (a buildup of fluid in the brain)
• hypothyroidism (an underactive thyroid)
• vitamin B-12 deficiency

More recently, one 2020 study identified a kind of inflammation in the brain that may lead to dementia symptoms and found that early diagnosis and treatment are important to reverse the disease.

Whether the cause of dementia can be identified and treated or not, it is still important to get an early diagnosis. It is a progressive disease, so an early diagnosis can help plan for and manage the condition for the remainder of the person’s life.

A primary care physician is often the first step for diagnosis, followed by neurologists who specialize in the brain and nervous system.

Managing symptoms

Management of dementia falls typically into three main categories: nursing, social work, and palliative medical interventions (specialized medical care). Nurses and social workers will ensure that the person is in a safe environment at home. 

They will engage the individual in activities that can help promote wellness and maintain daily function, for example, being physically active and doing activities that stimulate the brain. 

They will also help guide people with dementia in stopping activities that may exacerbate symptoms, such as smoking, drinking, and drug use.

Self-care will also include writing down everyday tasks to help stay organized, keeping up hobbies and social activities, and trying new ways to engage the brain.

There are some medications that can help manage dementia symptoms, including: 

• Cholinesterase inhibitors: These are often prescribed for people with mild, moderate, and severe Alzheimer’s to help improve some symptoms, such as the ability to think clearly. Examples include donepezil (Aricept) and rivastigmine (Exelon)
• NMDA receptor antagonist: These medicines, such as memantine (Namenda), are used to slow the loss of brain function and even improve memory and the ability to process information in people with severe Alzheimer’s disease and vascular dementia.
• Blood pressure and cholesterol medications: These can prevent additional damage to the brain in those with vascular dementia. Examples include simvastatin (Flolipid).
• Selective serotonin reuptake inhibitors (SSRIs): These can help manage depression in people living with dementia. Examples include sertraline (Zoloft) and fluoxetine (Prozac).

There are two medications that can be used to slow the progression of Alzheimer’s disease, rather than simply treating the symptoms. These are aducanumab (Aduhelm) and lecanemab (Leqembi).

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Summary

It is important to diagnose dementia early so that the cause of the symptoms can be identified and more steps can be taken to reduce the effect of the disease on the person’s life. 

In some cases, dementia is caused by a condition that can be treated. So while dementia itself is not reversible, the condition causing dementia can be treated, which can improve symptoms. 

In most cases, such as with Alzheimer’s, dementia is progressive and the goal is to slow the decline in thinking and memory problems. Specialized care options and medications are used for this purpose. More research is underway to find new ways to treat dementia. 

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