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People who are recently diagnosed and their families should begin to make plans for the future. If possible, make decisions while the person is able to participate in the decision making. These are difficult but important conversations. Questions include:

• What kind of care does the person need right now?
• Who will take care of the person in the future?
• What can the family expect as the disease progresses?
• What kind of planning needs to be done?

As soon as possible after dementia is diagnosed, family members should discuss what financial and legal planning will be needed. Along with a will, the person should write a living will and assign a durable power of attorney for health care. These documents will ensure that the person's wishes for medical care, especially life-sustaining treatment, are recorded. For more information, see Writing an Advance Directive.

Ongoing treatment

The goal of ongoing treatment for dementia is to keep the person safely at home for as long as possible and to provide support and guidance to the caregivers.

Health professionals will work with the person and his or her family or other caregivers to improve mental function as much as possible. Adjustments to the home can make the person's life easier and safer. You can install handrails in showers and remove rugs to improve safety. Calendars and lists can aid memory; you can place sticky notes or signs with pictures on them around the house to help the person remember where objects are stored and to guide the person to the bathroom or kitchen. For more information, see the Home Treatment section of this topic.

The person may also take medicines such as:

• Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), or rivastigmine (Exelon). These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias to improve or maintain mental function. Recent studies indicate that this class of drugs holds promise for the treatment of people with vascular dementia. Both donepezil and galantamine have been shown to improve mental function with few side effects.^{10, 11} Rivastigmine may help people with dementia with Lewy bodies, but side effects such as nausea, vomiting, and weight loss are common.¹² At present, cholinesterase inhibitors can slow but not stop the progress of dementia. It is not clear how long these medicines will work. They may only stop the progress of dementia for a short time.
• Memantine (Namenda). This new type of medicine can slow the late stages of Alzheimer's disease. It may also benefit those with mild to moderate vascular dementia.^{13, 12} More studies are under way.
• Antidepressants to treat depression. They must be used carefully because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are SSRIs, such as fluoxetine (Prozac, for example) and citalopram (Celexa).¹⁴
• Medicines to ease anxiety, agitation, aggression, and hallucinations, which can become worse as dementia progresses. Some of these medicines, called atypical antipsychotic drugs, are not approved by the FDA for the treatment of dementia. Studies of people with psychosis due to dementia who were treated with these medicines, including Zyprexa and Risperdal, found an increased risk of death.¹⁵ Discuss this risk with your doctor before using these medicines.