Medication for dementia symptoms
Although no current medications stop, slow down or reverse dementia, some can temporarily help a person with their memory and thinking.
There are four medications approved in the UK to ease a person’s dementia symptoms, including memory and thinking problems:
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.
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.
Dementia medication side effects
Learn about possible dementia medication side effects and what to do if you experience them.
Who do dementia treatments help?
Medications for memory and thinking help some people more than others. In clinical trials involving people with Alzheimer’s disease who have taken a cholinesterase inhibitor for six months:
- about one out of ten people will show a clear improvement in their memory and thinking
- about one out of ten people will experience unpleasant side effects
- around eight out of ten people will feel no noticeable difference.
There have been fewer clinical trials involving people who have dementia with Lewy bodies or Parkinson’s disease dementia. However, there is evidence to suggest that the benefits of cholinesterase inhibitor medications are greater in these conditions than for Alzheimer’s disease.
It’s not possible to know in advance if a person’s symptoms will improve with treatment, as everyone responds differently. However, many people feel that it’s worth trying.
If the medication doesn’t seem to be helping, it’s important to speak to the GP before stopping. When a medication does help someone, symptoms tend to improve after a few weeks. This then usually lasts for between six and 12 months. At some point, the symptoms will gradually start to get worse again, even when the person is still taking the medication.
Researchers have tried to see if these medications also help with changes in behaviour, such as agitation or aggression. Unfortunately, it’s currently unclear if they do.
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.
A person in the early or middle stages of dementia caused by Alzheimer’s disease may find that taking donepezil or rivastigmine helps with their:
- mental abilities, such as memory, concentration and thinking
- ability to continue doing daily activities (such as managing money, shopping or cooking)
A person in the early or middle stages of dementia with Lewy bodies or Parkinson’s disease dementia may find that taking donepezil or rivastigmine helps with their:
Most people start taking a 5mg donepezil tablet once per day. This is often increased to 10mg per day (the maximum licensed dose) after four weeks.
With rivastigmine, most people start taking a 1.5mg capsule twice a day, with morning and evening meals. The dose can then be increased every few weeks, up to a maximum of 12mg a day.
Rivastigmine is also available as a skin patch, which can help when a person has difficulty taking medication by mouth, or if it makes them feel sick.
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.
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.
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.