Medication for dementia symptoms

There are four medications approved in the UK to ease a person’s dementia symptoms, including memory and thinking problems:

• donepezil
• rivastigmine
• galantamine
• memantine. 

These treatments are only effective for people with Alzheimer’s disease, dementia with Lewy bodies, Parkinson’s disease dementia, and mixed dementia involving any of these types.

There aren’t yet any medications that improve the symptoms of vascular dementia or frontotemporal dementia. However, medications should never be considered as the only source of hope. Information and advice, activities, social support, and treatments that don’t involve medication are just as important in helping someone to live well.

Is dementia medication free?

Medications to treat memory and thinking problems are only available on prescription. They are free in England for people who are 60 and over, or who have a payment exemption. In Northern Ireland and Wales, they are free to everyone.

Types of dementia medication 

Many dementia medications have at least two names: 

• a name for the main substance in the medication, such as donepezil
• a brand name, such as Aricept. 

*  Slow-release capsules release the medication into the body gradually. Standard tablets and capsules release the medication into the body as soon as they are swallowed. 

How do these dementia medications work? 

Donepezil, rivastigmine and galantamine belong to a group of medications called cholinesterase inhibitors and they all work in a similar way. Memantine works differently.  

Donepezil, rivastigmine and galantamine 

A healthy brain contains natural chemicals that allow nerve cells to talk to each other. One of these chemicals is called acetylcholine. When a person has Alzheimer’s disease or dementia with Lewy bodies, they have less acetylcholine. This means that their nerve cells lose the ability to talk to each other properly. 

Cholinesterase inhibitors, like donepezil, rivastigmine and galantamine, can boost acetylcholine levels. This helps to keep the brain working normally for longer. All three cholinesterase inhibitors work in a similar way, but one might be better for someone than another. For instance, a person may have fewer side effects from one. 

Eventually, the disease will damage enough of the brain that these medications have much less of an effect. At this stage, the person’s symptoms will start to get worse again. 

Memantine for dementia 

Memantine works differently to the other medications. People with Alzheimer’s disease can have too much of a chemical called glutamate. This damages their nerve cells and makes it harder for them to send messages. Memantine protects a person’s nerve cells by blocking glutamate.

How much do dementia medications help? 

If you’ve been diagnosed with Alzheimer’s disease, Lewy body dementia, or mixed dementia involving either of these conditions, you should be offered medication unless there is a medical reason why you can’t take it.

Medications can help to improve your memory and thinking. They can also make it easier to do everyday tasks, like preparing meals, washing and dressing. People with Lewy body dementia may find that they help to reduce visual hallucinations, confusion and sleepiness during the day.

Not everyone feels the same amount of benefit from dementia medications. Some people notice a clear improvement in their symptoms within weeks. Others may not notice an obvious benefit, or they may have persistent side effects that outweigh the benefits.

The overall benefit of dementia medications are modest – they don’t make symptoms go away and they don’t stop the disease in your brain. You can choose not to take them if you don’t want to. However, for many people they may be worth trying.

When are dementia medications prescribed?

Most people are offered medication around the time of their diagnosis with dementia. It is not offered to people who have less severe symptoms, known as mild cognitive impairment (MCI), because there is not enough evidence that it helps at this stage.

Most people start by taking a cholinesterase inhibitor, such as donepezil. This can help to improve or stabilise symptoms for around six to 12 months. After this, symptoms gradually start to get worse again. When this happens you should be offered another medication called memantine, which can be taken on top of the donepezil. Together these can help with symptoms during the middle and late stages of dementia. But often people are not offered this medication unless they ask for it.

Most people continue to be prescribed medications for their dementia symptoms unless there is a good reason to stop.

Donepezil and rivastigmine

Donepezil tablets are by far the most common medication used to treat dementia. Rivastigmine tends only to be used when donepezil causes side effects, or if the person can’t take it for medical reasons.

When is galantamine prescribed?

Galantamine isn’t prescribed very often. It can be used to treat the symptoms of Alzheimer’s disease. However, doctors are more likely to offer a person donepezil and rivastigmine first.

It’s not known whether galantamine helps people with dementia with Lewy bodies or Parkinson’s disease dementia.

Dose

A person taking galantamine would normally start taking a 4mg capsule twice a day, with morning and evening meals. The dose can then be increased every few weeks up to a maximum of 24mg a day. Galantamine is also available as a slow-release version, which can help to reduce side effects.

When is memantine prescribed?

Memantine is used to treat people in the middle and later stages of Alzheimer’s disease or dementia with Lewy bodies. It can help with worsening mental abilities, such as confusion or feeling lost, and problems carrying out daily activities, such as getting dressed.

There is some evidence that memantine may also sometimes help with delusions, aggression and agitation.

Taking both memantine and a cholinesterase inhibitor may sometimes help someone with late-stage Alzheimer’s more than the cholinesterase inhibitor alone. This may be because the drugs work in different ways.

Dose

It’s common for a person starting to take memantine to be given a ‘starter pack’. This contains pills of different strengths to allow them to work up to an effective dose over several weeks. They start with a low dose of 5mg a day and then increase every week by 5mg, up to 20mg a day after four weeks.