The Australian Institute of Health and Welfare (2021) reported that in the 2019-20 financial year 623,300 prescriptions were written for dementia-specific medications.
Clinical trials demonstrate modest, but significant effects for the anticholinesterase inhibitors (donepezil, rivastigmine and galantamine) and memantine, which blocks NMDA receptor channels which reduces the excitoxicity of glutamate. These medications are symptomatic treatments, not disease modifiers, that is they slow the rate of cognitive decline but do not affect the build of brain pathology. All come with potential side-effects that in some cases are clinically significant – gastrointestinal upset, nightmares or disturbed sleep, increased risk of bleeding, bradyarrhythmias.
Amid much controversy, the first disease modifying drug, Aducanumab was approved by the USA FDA and is currently being trialled in Australia. Expert opinion remains divided on whether Aducanumab will eventually prove useful.
This drug only targets Alzheimer’s disease, while it is the most common form of dementia, it is only one of many causes of dementia. Medication is only one part of comprehensive support for people living with dementia and their carers. There is the potential to do more.
Pharmacists and pharmacy assistants play a key role interacting with people with dementia and carers who live in the community. A new website, Forward with Dementia could prove a useful adjunct when filling prescriptions for newly diagnosed patients. Forward with Dementia is an innovative online program, co-designed with people living with dementia, carers and health care professionals, that provides support in the first year after diagnosis.
Separate sections of the website for people with dementia and carers provide tailored information, advice, tools and resources. There are inspirational stories about how people managed their symptoms to overcome stigma and live positively with dementia, and there are news items regarding new dementia drugs, driving (or giving up driving) and more.
Bill, a person living with younger onset dementia said: “I wish I had had this website when I was first diagnosed. It would have given me the information and support I needed to move forward.”
The website has pithy, short and informative articles article is accompanied by ‘action items’ – practical things to do to help come to terms with and approach dementia more positively as well as plan for the future to feel a sense of control. The website has been designed to enable people to use it independently, but encourages seeking further support as they are ready.
The website has a section for health professionals, currently primarily targeting medical practitioners, where you can find downloadable and printable resources, including promotional flyers.
This international project is being conducted in Canada, UK, Netherlands and Poland. Led by Australia the project is funded by the NHMRC and conducted by the Universities of NSW, Sydney and Wollongong. The website was co-designed by people living with dementia, carers and health care professionals.
For more information, please contact forwardwithdementia@unsw.edu.au
Authors
Meredith Gresham, PhD, Research Co-ordinator, NSW Sydney
Henry Brodaty, Scientia Professor of Ageing and Mental Health, UNSW Sydney
