Dementia is an umbrella term used to classify multiple diseases that are caused by changes in the brain, leading to a decline in cognitive function, causing significant impairment in many people’s lives. Unfortunately, there is no cure for dementia, though there are many classes of dementia medications that can be used to effectively manage dementia symptoms. Many people ask about the best medications for dementia – while what may be best for someone will vary based on their unique situation, we will try to provide you with a foundational overview here.
One of the goals of medications in dementia is to try to slow down the progression of the disease to a manageable level, allowing for a relatively more comfortable living style. When starting a medication regimen, your clinician should ensure to start at a low dose then gradually increase according to the person’s response. Your clinician will consider associated side effects and also be mindful of any potential harmful drug interactions that may worsen your condition. It is generally recommended to take only one dementia-related medication at a time to start, so as to fully understand each drug’s benefits and possible side effects. Please consult your doctor regarding taking these medications, and whilst taking them as well – do not make any changes to the dosage without consulting them first.
Here we will list dementia medications, categorized by their intended effect, and how that effect is achieved. These dementia medications are great memory loss treatment options that can often help in managing dementia symptoms.
Dementia Medications that try to Prevent Cognitive Decline: Cholinesterase Inhibitors
Acetylcholine is an important neurotransmitter, or chemical in the brain, that is linked to learning and memory. It aids in the communication between neurons in the brain. These medications will prevent acetylcholine from naturally breaking down, allowing it to be found in abundant and plentiful amounts. Often, those with dementia will have lower acetylcholine levels in their brains. Side effects for these medications can include: nausea, diarrhea, weight loss, and a low heart rate. The following cholinesterase inhibitors are designed to try to prevent acetylcholine breakdown:
- Donepezil (Aricept™)
- Galantamine (Reminyl™)
- Rivastigmine (Exelon™)
Dementia Medication that Stops Nerve Cell Damage: NMDA Receptor Antagonist
Glutamate is another neurotransmitter that helps send messages between brain cells. However, for those with dementia, glutamate is often released in high amounts, overloading receptors in the brain and potentially causing damage to nerve cells. To counteract this, this drug blocks off the receptor so that glutamate cannot bind with it, thus preventing nerve cell decay. Though this medication may be a good option for those that may not be able to deal with the symptoms of cholinesterase inhibitors, it too may have side effects, including: headaches, dizziness, constipation, and confusion.
- Memantine (Ebixa®)
Medications that Can Possibly Alter the Progression of Dementia: Anti-Amyloid Treatments
These dementia medications attempt to remove the protein beta-amyloid in the brain. Build up of this protein can lead to the development of a type of plaque. Plaques form when the beta-amyloid protein accumulates abnormally around nerve cells. Normally, beta-amyloid is found in fatty membranes that cover and protect nerve cells in the brain. However, in the case of dementia onset, these proteins may clump together, becoming sticky and forming plaque-like aggregations. These plaques block nerve cells from communicating with one another. This will eventually lead to impaired function commonly associated with dementia. In addition, inflammation in the brain will occur which will subsequently lead to nerve cell damage. Inevitably, this may lead to nerve cell death, a key feature of dementia. The following medications are known as monoclonal antibodies that stick to the beta-amyloid plaque. Acting as antibodies, they will signal the immune system to remove the plaque bodies. They are both intravenous (IV) infusion therapies. As with other medications, there are side effects associated with these medications which can include: brain swelling, and leaking blood vessels in the brain.
- Lecanemab (Leqembi®): infusion every two weeks.
- Donanemab (Kisnula™): infusion every four weeks.
Aducanumab (Adulhelm™) was also a monoclonal antibody that was in use from 2021-2024 but then discontinued.
Behavioral and Psychological Symptoms of Dementia
Often, those with dementia will also experience behavioural and psychological changes. These changes can lead to significant changes in personality and behaviour compared to how they used to be with those around them. This occurs because the nerve cells die in different parts of the brain that regulate these characteristics associated with their personality. Common changes noticed include: depression, anxiety, frustration, agitation, hallucinations, and disorientation. To help manage these dementia symptoms, the following medications can be considered:
Managing Dementia Symptoms: Antidepressants – Selective Serotonin Reuptake Inhibitors (SSRI)
To treat symptoms of anxiety and depression, antidepressants are commonly prescribed. Antidepressants work by targeting serotonin, a common neurotransmitter in the brain. Normally, serotonin works to influence mood and emotion in a positive manner – they are then taken up and reabsorbed inside the brain. To mitigate depression and anxiety, SSRIs are prescribed to keep serotonin active and concentrated within the brain. SSRIs have also been shown to reduce symptoms of agitation and aggression in those with dementia. SSRI side effects can include: nausea, headaches, sweating, sleepiness, and shakiness. There are many different SSRIs and a few common ones are listed below:
- Sertraline (Zoloft)
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
Managing Dementia Symptoms: Antipsychotics (Typical: 1st Generation & Atypical: 2nd Generation)
Antipsychotics can be prescribed to help manage hallucinations, and delusions. These are symptoms generally categorized under the condition known as psychosis. Psychosis impacts the experiences of those with dementia – they will often believe something is real when it is not. Psychosis can be both gradual or sudden in nature. Typical antipsychotics block the effect of the neurotransmitter dopamine. Dopamine may initiate psychotic episodes and perpetuate delusions. Thus by blocking the effects of dopamine, psychosis may be reduced. Atypical antipsychotics work in a similar fashion, but also block serotonin to further reduce the effects of psychosis. In recent years, atypical antipsychotics have been more commonly prescribed due to reduced side effects compared to the older typical antipsychotics. Side effects of typical antipsychotics can include: drowsiness, dry mouth, blurred vision, spasms. Side effects of atypical antipsychotics may include: movement effects, weight gain, diabetes, seizures, dizziness, and agitation. Some examples of each are listed below:
- Typical Antipsychotics
- Haloperidol (Haldol®)
- Chlorpromazine (Thorazine®)
- Flupenthixol (Fluanxol®)
- Fluphenazine (Prolixin®)
- Loxapine (Loxatine)
- Atypical Antipsychotics
- Risperidone (Risperdal®)
- Quetiapine (Seroquel®)
- Olanzapine (Zyprexa®)
- Brexpiprazole (Rexulti®)
- Clozapine (Clozaril®)
Dementia is a complicated condition that can manifest itself in many different ways. Though at the moment dementia is not curable, its symptoms can be managed with the aid of dementia medications. These include memory loss treatment options in the form of cholinesterase inhibitors and NMDA receptor antagonists. Using anti-amyloid treatments can also slow the progression of dementia. In addition, because dementia is accompanied by a variety of behavioural and psychological symptoms, antidepressants (SSRIs) can be prescribed to mitigate the effects of dementia and anxiety. Further, antipsychotics can be prescribed to manage psychosis symptoms, including hallucinations and delusions.
While these dementia medications are great options to manage dementia symptoms it is important to consult your doctor before starting to use these medications. It is also important to note that these medications may have associated side effects that can vary in intensity. Always consult your doctor when on these medications and seek help immediately if any sudden and drastic changes occur.
Resources
https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019#:~:text=These%20medicines%20work%20by%20boosting,be%20prescribed%20for%20other%20dementias.
https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
https://memory.ucsf.edu/treatments-stays/medications-dementia
https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2
https://my.clevelandclinic.org/departments/neurological/depts/brain-health/anti-amyloid-therapy-faq
https://memory.ucsf.edu/caregiving-support/behavior-personality-changes
https://pmc.ncbi.nlm.nih.gov/articles/PMC5953267/
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
https://www.alz.org/alzheimers-dementia/treatments/treatments-for-behavior
https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/antipsychotic-medication
