Medicinal Treatments for Dementia

When a loved one receives a dementia diagnosis, the first question is usually “How can it be treated?” 

There is no single medicine that works for every person or every type of dementia. Some medicines can help manage symptoms such as memory problems, confusion, and difficulties with thinking, while others may be prescribed to manage symptoms or conditions that occur alongside dementia.

The type and stage of dementia, other health conditions, existing medicines, and the person’s response to treatment can all affect which medication is suitable. For some people, medication may provide a noticeable improvement or help maintain their abilities. For others, the benefits may be limited, or side effects may make treatment unsuitable. 

Medication for dementia generally falls into symptom management and new disease-modifying treatments. This article will focus on the traditional medicines that are used to temporarily ease cognitive difficulties (such as memory loss, confusion, and concentration) or manage associated symptoms like depression, anxiety, or agitation.

For more information on the newly developed disease-modifying treatments, see our dedicated article.

Can Medication Cure Dementia?

There is currently no medicine that cures dementia or reverses the underlying brain changes that cause it.

The medicines used to manage dementia symptoms are not designed to stop the underlying disease from progressing. Instead, they can affect the chemical processes involved in communication between nerve cells, which may help some people manage symptoms for a period of time. 

The response varies considerably. Some people notice an improvement in symptoms, while others may experience more of a stabilising effect, allowing them to maintain certain abilities for longer. Some people notice little benefit, or experience side effects that outweigh any advantages.

Studies of the effectiveness of these treatments show moderate improvements for the majority of users. However, treatment is usually reviewed over time rather than assuming that a particular medicine will work indefinitely. 

Why the Type of Dementia Matters

Dementia is an umbrella term for several conditions, each affecting the brain differently. As different types of dementia involve different chemical pathways, a medicine that helps one condition may be ineffective or even harmful for another.

NICE (the National Institute for Health and Care Excellence) provides clear guidance on which medicines should be considered based on the underlying diagnosis:

Prescribing decisions are complex. A doctor will evaluate a person’s exact diagnosis, overall physical health, existing prescriptions, and specific symptoms before recommending any treatment.

Acetylcholinesterase inhibitors

Donepezil, rivastigmine, and galantamine belong to a group of medicines called acetylcholinesterase inhibitors, often shortened to AChE inhibitors.

They work by slowing the breakdown of acetylcholine, a chemical messenger involved in communication between nerve cells. Alzheimer’s disease and some other forms of dementia are associated with reduced acetylcholine. 

By slowing its breakdown, these medicines can increase the amount of acetylcholine available for nerve-cell communication. This may help improve or stabilise some symptoms for a period of time, although the effect varies between people.

Donepezil

Donepezil is usually the first AChE inhibitor used to manage symptoms of Alzheimer’s disease. It can also be used for dementia with Lewy bodies and, in certain circumstances, Parkinson’s disease dementia. 

It may help some people with symptoms such as forgetfulness and confusion; however, the aim is not to produce a dramatic improvement or to cure the underlying condition. When using this medication, you may notice improved concentration, easier management of daily tasks, reduced confusion, and greater alertness. However, some people experience no obvious change.

This medication can be taken orally as a tablet or liquid. It can produce side effects, such as:

• Diarrhea, vomiting, and nausea.
• Loss of appetite.
• Muscle cramps.
• Difficulty sleeping.
• Unusual tiredness and weakness.

Rivastigmine

Rivastigmine is an AChE inhibitor that works similarly to donepezil and is prescribed for mild-to-moderate Alzheimer’s disease, dementia with Lewy bodies, and Parkinson’s disease dementia.

This medication is available as an oral medicine and a transdermal skin patch. The patch releases medication continuously through the skin over 24 hours. This also offers an alternative for individuals who have difficulty swallowing pills, experience gastrointestinal side effects from oral tablets, or struggle with daily medication routines.

When taken orally, this medication can cause side effects, including:

• Nausea, vomiting, and diarrhea.
• Indigestion.
• Loss of appetite and weight loss.
• Loss of strength.
• Fainting.

However, this medication, taken transdermally, can cause side effects, including:

• Bladder pain, loss of bladder control, and painful urination.
• Lower back or side pain.
• Dizziness and blurred vision.
• Slow or fast heartbeat.
• Headaches. 
• Skin redness/irritation at the site of the patch.

Galantamine

Galantamine is also an AChE inhibitor primarily used for mild-to-moderate Alzheimer’s disease. In addition to preventing the breakdown of acetylcholine, galantamine stimulates nicotinic receptors in the brain, further encouraging the release of acetylcholine.

This medication can cause side effects, such as:

• Chest pain or discomfort.
• Lightheadedness, dizziness, or fainting.
• Shakiness in the legs, arms, hands, or feet.
• Shortness of breath.
• Slow or irregular heartbeat.
• Unusual tiredness.

People respond differently to AChE inhibitors. If one medicine causes troublesome side effects or is not suitable for another reason, a healthcare professional may consider an alternative. 

Memantine

Memantine works differently from donepezil, rivastigmine and galantamine. It is an NMDA receptor antagonist and affects the activity of a chemical messenger called glutamate.

Alzheimer’s disease can disrupt the way glutamate works in the brain. Memantine reduces the effects of excessive glutamate, which may help some people with symptoms affecting cognitive function, confusion, and behavioural changes (BPSD) that are seen in the later stages of dementia.

Memantine is mainly used for moderate to severe Alzheimer’s disease. It may be prescribed on its own when an AChE inhibitor is unsuitable or cannot be tolerated. It can also be prescribed alongside an AChE inhibitor as Alzheimer’s disease progresses. 

While Memantine is generally well-tolerated, side effects may include:

• Dizziness and balance problems.
• Headaches.
• Constipation.
• Breathlessness.
• Elevated blood pressure.
• Unusual tiredness.

Can Dementia Medicines Be Taken Together?

Yes, in some circumstances. As Alzheimer’s disease progresses to more advanced stages, doctors may recommend combining an AChE inhibitor with memantine. The two medicines work in different ways, so combining them may provide additional symptom management for some people. 

Combining an AChE inhibitor with memantine is a clinical decision made by a healthcare specialist. However, two different AChE inhibitors should never be taken simultaneously, as this significantly increases the risk of severe side effects without added benefit.

How Much Do Symptom Medicines Actually Help?

It is important to have realistic expectations about dementia medication. These medicines do not restore lost memories or stop dementia from progressing. 

For most who benefit, the effect is subtle, slowing down the rate at which symptoms worsen over several months or a couple of years.

Roughly 40% to 70% of people taking AChE inhibitors notice some benefit, while others notice no difference at all. As dementia progresses, symptoms may become more noticeable even when medication is still providing some benefit. Healthcare professionals can review the person’s symptoms, daily functioning, and side effects to decide whether continuing treatment remains appropriate.

Medicines for Associated Symptoms

Dementia affects much more than memory. This condition impacts mood, sleep patterns, and physical discomfort. Doctors may prescribe secondary medications to manage these challenges when non-drug measures are insufficient.

Depression and anxiety

Depression and anxiety can affect people living with dementia, but mood changes should be assessed carefully rather than automatically treated with medication.

For mild to moderate depression or anxiety, NICE recommends considering psychological treatments. Antidepressants are not routinely recommended for mild to moderate depression in people living with dementia.

Sleep problems

Changes to sleep are common in dementia. Before considering medication, healthcare professionals may look at factors such as pain, anxiety, changes to routine, lack of daytime activity and exposure to daylight. Medication is not routinely used simply to make someone with dementia sleep.

Pain

Pain can sometimes present as changes in behaviour, particularly when someone has difficulty communicating what they are experiencing. A healthcare professional may therefore assess for pain when someone becomes unusually distressed, withdrawn or agitated.

Treating an underlying physical problem may reduce distress without needing medication specifically aimed at behavioural symptoms.

Managing Behavioral Changes

When a person living with dementia experiences distress, agitation, aggression, hallucinations or delusions, medication is not usually the first step. NICE recommends carrying out a structured assessment to look for possible causes, including physical health problems and environmental factors. These might include:

• Unmanaged physical pain or discomfort.
• Infections (such as a urinary tract infection or chest infection).
• Constipation or dehydration.
• Environmental overstimulation, noise, or unfamiliar surroundings.
• Frustration, fear, or sensory deprivation (e.g., unserviced hearing aids).

NICE guidelines mandate that structured clinical assessments and non-pharmacological interventions must be tried before considering behavioral drugs.

Antipsychotic Medications

Antipsychotic drugs (such as risperidone or haloperidol) may sometimes be prescribed, but only in specific circumstances. NICE recommends considering them when a person is at risk of harming themselves or others, or when agitation, hallucinations or delusions are causing severe distress. 

These medicines can have serious side effects, including an increased risk of stroke and death in people living with dementia. If an antipsychotic is prescribed, NICE recommends using the lowest effective dose for the shortest possible time. 

Antipsychotics also require particular caution in people with dementia with Lewy bodies or Parkinson’s disease dementia, as they can worsen motor symptoms and may cause severe sensitivity reactions.

Why Some Existing Medicines Can Worsen Dementia Symptoms

Certain everyday medications prescribed for other conditions can actively worsen memory loss, confusion, and daily function. Many medicines block acetylcholine, the exact chemical that drugs like donepezil attempt to boost. The cumulative effect of taking multiple drugs with these properties is known as anticholinergic burden.

Common examples of drugs with anticholinergic effects include:

• Antihistamines (used for allergies).
• Certain urinary incontinence treatments.
• Specific muscle relaxants and overactive bladder medications.
• Certain older tricyclic antidepressants.

This does not mean that someone should stop taking these medicines. Instead, a medication review with a GP, pharmacist or other appropriate healthcare professional can identify medicines that may be contributing to cognitive problems and whether safer alternatives are available. Never stop a prescribed medicine without professional advice.

What Happens When Dementia Medication Stops Working?

Families may worry when dementia symptoms become more noticeable despite medication. However, this does not necessarily mean that the medicine has suddenly stopped working.

Dementia is a progressive condition, and symptom-managing medicines do not stop the underlying disease from progressing. Someone may therefore continue to take a medicine that provides some benefit while their symptoms gradually become more noticeable.

If there are concerns that medication is no longer helping, a healthcare professional can review the person’s symptoms, daily abilities, side effects and other medicines before deciding whether treatment should continue or change.

NICE guidance advises that AChE inhibitors should not be routinely discontinued simply because the dementia has progressed to a severe stage, provided the person tolerates the medicine without severe side effects. Make any decision to stop or change dementia medication gradually, in consultation with a doctor.

How Dementia Medications Are Monitored

Dementia medication is usually reviewed regularly. The exact monitoring required depends on the medicine and the person’s health, but it may consider:

• Whether the person’s symptoms or daily functioning have changed.
• Whether there are noticeable benefits from treatment.
• Side effects or new health problems.
• Other medicines the person is taking.
• Whether the person is able to take the medicine as prescribed.
• Whether the balance between potential benefits and risks has changed.

For some people, healthcare professionals may also monitor things such as weight, blood pressure or pulse, depending on the medicine and the person’s medical history.

What Medication Cannot Do