Treatment of Cognitive Impairment

Last updated on 12/03/2025

Pharmacological Treatment

Medication use in nursing homes must balance symptom management with minimising side effects. But please note that medication is a last resort and must be prescribed by the treating Medical Doctor.

Cognitive-Enhancing Medications

  1. Cholinesterase Inhibitors (Donepezil, Rivastigmine, Galantamine) – Used for mild to moderate Alzheimer’s disease.
  2. NMDA Receptor Antagonists (Memantine) – Used in moderate to severe dementia.

Medications for Behavioural and Psychological Symptoms of Dementia (BPSD)

  1. Antipsychotics (Risperidone, Quetiapine) – Used cautiously for aggression and hallucinations, but with an increased risk of stroke.
  2. Antidepressants (Sertraline, Mirtazapine) – Used for mood disturbances and anxiety.
  3. Melatonin or Low-Dose Trazodone – May be used for sleep disturbances.

Pain Management

  1. Uncontrolled pain can lead to increased agitation. Regular pain assessments are necessary, particularly for non-verbal residents. Paracetamol is often first-line, with opioids used cautiously.

 

 

Non-Pharmacological Approaches

Non-drug interventions play a vital role in managing behaviours and enhancing well-being.

Cognitive and Sensory Stimulation

  1. Cognitive Stimulation Therapy (CST) – Group-based activities such as storytelling, puzzles, and discussions.
  2. Reminiscence Therapy – Using old photographs, music, and familiar objects to stimulate memory.
  3. Reality Orientation Therapy – Providing frequent reminders about time, place, and events to reduce confusion.

Behavioural and Psychosocial Interventions

  1. Personalised Care Plans – Tailored to individual preferences and life history.
  2. Validation Therapy – Accepting the person’s reality rather than correcting them.
  3. Doll Therapy & Pet Therapy – Can help reduce distress in some individuals.
  4. Montessori-Based Activities – Task-focused engagement, such as sorting, folding, or matching objects.

Sensory-Based Interventions

  1. Music Therapy – Helps reduce agitation and improve mood.
  2. Aromatherapy – Some evidence suggests lavender and lemon balm may help with agitation.
  3. Multisensory Environments (Snoezelen Therapy) – Controlled sensory stimulation using lights, sounds, and textures.

Environmental and Routine Adaptations

  1. Dementia-Friendly Design – Clear signage, colour contrasts, and familiar objects.
  2. Consistent Routines – Minimises anxiety caused by unpredictability.
  3. Quiet Spaces – Reducing overstimulation to manage agitation.

 

 

Functional and Physical Health Support

Occupational Therapy (OT) Interventions

  1. Adaptive Equipment – Weighted utensils, non-slip mats, and one-handed dressing aids.
  2. Task Simplification – Breaking activities into manageable steps.

Physiotherapy

  1. Falls Prevention – Balance exercises, walking aids, and muscle strengthening.
  2. Pain Management – Gentle movement therapy for arthritis and joint stiffness.

Speech and Language Therapy (SLT)

  1. Dysphagia Management – Texture-modified diets, swallowing strategies, and posture adjustments.
  2. Communication Strategies – Visual supports, simplified language, and gestures.

Nutritional Support

  1. Dietitian Input – Weight monitoring, protein supplementation, and hydration strategies.
  2. Mealtime Adaptations – Finger foods, brightly coloured plates for contrast, and reducing distractions.

 

 

Lifestyle and Preventative Strategies

  1. Diet (Mediterranean or MIND diet) – Rich in antioxidants, omega-3, and low in processed foods.
  2. Social Engagement – Interaction with others slows cognitive decline.
  3. Sleep Hygiene – Addressing sleep disorders, particularly in LBD and AD.
  4. Mental Stimulation – Activities such as puzzles, reading, and learning new skills.

 

 

Palliative and End-of-Life Care

As dementia progresses, a palliative care approach is integrated to maintain comfort and dignity.

  1. Advance Care Planning – Discussing preferences with family and carers.
  2. Pain and Symptom Control – Managing distress, breathlessness, and discomfort.
  3. Non-Verbal Communication – Recognising pain through facial expressions, body language, or vocalisations.
  4. Emotional and Family Support – Grief counselling, memory boxes, and life story work.

 

 

Staff Training and Family Involvement

  1. Person-Centred Dementia Care – Training staff to understand and respect personal histories and preferences.
  2. Family Engagement – Encouraging regular visits, involvement in activities, and shared decision-making.
  3. De-Escalation Techniques – Supporting staff in managing aggression and distress without resorting to sedation.