Medications & Dementia
It is generally a good idea to try nondrug interventions before turning to medications, but sometimes medications are necessary.

This page will discuss:

  1. Medications recommended for managing the symptoms associated with dementia
  2. Medications to avoid in people with cognitive problems

 

Managing the changes associated with dementia requires a thoughtful approach. Any dramatic or sudden change in cognition, movement or behavior should be evaluated for a medical condition that may require treatment, such as an infection or pain. Untreated concurrent medical problems can lead to behavioral problems, especially if the person with dementia is having difficulty communicating.

Once a medical condition is ruled out, attempts to manage the symptoms with nondrug interventions is generally recommended first before using medications.

While medications can be very helpful, some medications can cause new problems and should be avoided. Others might need their doses to be adjusted to provide benefits or to reduce side effects. Some medications may no longer be needed or alternative treatments, including non-drug strategies, might be safer and more effective for you.

When medications are indicated, the general advice is to:

  • Start at a low dose and then increase slowly based on the patient’s response in order to maximize benefits and minimize side effects.
  • Avoid medications that may worsen memory and thinking or increase confusion, since people with cognitive problems may be particularly sensitive to the effects of certain medications.
  • Avoid drug interactions that may interfere with medications used to treat cognitive problems.
  • Make one medication change at a time to understand its effect.

It is important to see your doctor regularly while taking these medications. As the disease progresses and symptoms change, the medications or doses may need to change, or the medications might stop working or need to be stopped. Please consult with your doctors before making any changes to your medications and tell them about all medications you are taking, including prescription, non-prescription, vitamins, supplements and herbals.

Overview of Medications for People with Cognitive Impairment

Current medications can’t cure Alzheimer’s disease or other dementias, but they might be able to slow it down and make it easier to live with. They may relieve symptoms related to memory, thinking, language and other thought processes. In addition, they may also help with mood, agitation and other behavioral issues.

Medications may not work for everyone. People respond very differently to medications.

  • Sometimes the medications can lead to improvement in memory, cognition or behavior.
  • Sometimes they may not make a big difference, but memory, cognition or behavior may not decline or worsen as fast as without medications.
  • Sometimes the medications don’t work, have problematic side effects or seem to make things worse.
  • Usually the side effects go away after a few days, or the dose may need to be adjusted.

While these medications may cause side effects, many people are able to take them without problems.

Commonly Used Medications for Persons with Cognitive Impairment

Drug Name (Brand Name) Generic Available Uses Possible Side Effects
Donepezil (Aricept®) Yes All stages of dementia (not recommended in FTD) Nausea, diarrhea, vomiting, upset stomach, lack of hunger, weight loss or low heart rate. Other less common problems are feeling tired, having trouble sleeping, vivid dreams or muscle cramps.
Rivastigmine (Exelon®) Yes All stages of dementia (not recommended in FTD)
Galantamine (Razadyne®) Yes All stages of dementia (not recommended in FTD)
Memantine (Namenda®) Yes Moderate to severe stages of dementia; often used in combination with one of the drugs above (not recommended in FTD) Headache, dizziness, confusion or constipation

 

While none of these drugs are approved for use in mild cognitive impairment (MCI), some clinicians may prescribe them.

Treatment for Common Conditions and Symptoms

Below are common conditions and symptoms that persons with dementia often experience. For each condition, we list common medications to avoid because they may worsen memory and thinking, have problematic side effects or cause other problems, and safer alternatives to consider, both drug and non-drug interventions.

Medication Resources

Complementary & Alternative Medicine

Practitioners of complementary and alternative medicine (CAM) use health care practices and products that are not considered a part of the conventional medicine practiced by holders of medical, osteopathy, nursing and therapy degrees. The list of treatments considered CAM evolves regularly with new research. It is important to remember herbal and alternative treatments may interact with prescribed or nonprescription medications, and as with all treatments, possess the potential for side effects. Herbs are typically used in combination with each other and usually do not have serious side effects when used appropriately at suggested doses. It is not unusual for an individual to use complementary medicine and conventional medicine at the same time.

The Risks of Herbal Treatments

Many people feel that traditional herbal products are more “natural” and safer than conventional drugs. However, some herbal products may have the same actions and effects as prescription medications resulting in harmful drug interactions or side effects. Unlike prescription and over-the-counter medications, herbal products and other dietary supplements do not need to be proven safe or effective before they are sold. Herbs and supplements are essentially crude drugs with the potential for both beneficial and harmful effects.

Herbal products, dietary supplements or very high doses of vitamins or minerals can have dangerous drug interactions and side effects, just like prescription and other nonprescription products. Side effects may reflect the purity of the preparation or additives. Stop taking herbal products and contact your health care provider immediately if side effects, a rash or signs of an allergic reaction occur.

In some cases, the herbal content of a product is considerably more or less than the strength listed on the label. While most herbal products are safe, some products have been found to contain pesticides, heavy metals, toxic herbs or prescription medications. For this reason, it is recommended that only high-quality products be used.

Be safe. Talk with your doctor earlier rather than later. Your doctor can help determine if there are any dangerous side effects or drug interactions and help determine the right dosage for you. As with all medications, more is not better and can lead to serious illness and death.

Selecting Herbal Treatments

Many people ask about dietary supplements to help improve memory and cognition such as ginkgo, ginseng, turmeric, and some specific products like Prevagen, Focus Factor and Axona. Currently there is no strong data to support the use of these supplements to help improve memory and cognition or to treat dementia. Many of these supplements have side effects and drug interactions. Please discuss with your healthcare providers before starting any supplement, herbal or vitamin to ensure their safe use.

If you are considering an herbal treatment, here are a few questions you should ask first:

  • Is the product manufactured in the United States?
  • Is the manufacturer well known and reputable? (Ask your pharmacist)
  • Does the label list the name and form of the herb(s), the amount of the herb(s) in each dose in milligrams or grams, a lot number, and an expiration date? If you choose to use products brought in from other countries, read the label carefully with your pharmacist. Watch out for names of prescription drugs such as ephedrine and phenobarbital, which have been found in herbal products.
  • Does the label or product information list a toll-free number you can call for more information?
  • Call and ask how the raw herbs are accurately identified and how the product is tested for purity and potency. Some manufacturers will send a copy of their analysis to you and/or your physician, nurse or pharmacist. An independent laboratory (ConsumerLab.com) has tested some herbal products for purity and potency. Check their website and select an approved product or a manufacturer that clearly provides quality control.
  • Have you discussed the possible benefits and adverse effects of the product with your pharmacist and/or physician?

Ingredients to Avoid

  • Heavy metals: Excessive amounts of arsenic, lead and mercury have been found in some herbal products. Some, but not all, herbal product manufacturers have their raw herbs tested for heavy metal content.
  • Prescription drugs: Prescription drugs such as phenobarbital, ephedrine, chlorpheniramine, non-steroidal anti-inflammatory drugs, benzodiazepines, corticosteroids and methyltestosterone have been found in some herbal products, most often those manufactured overseas.
  • Misidentified herbs: The fact that some herbs can cause serious toxicity is well documented. The identification of raw herbs is traditionally made on the basis of appearance, taste, smell and feel. This may not be sufficient when the desired herb closely resembles a toxic botanical. In these instances, chemical analysis is required.

CAM Resources

Medical Cannabis (Marijuana)

Medical cannabis or medical marijuana for dementia is not a cure, but it has been used to help manage difficult behavior (e.g., agitation, aggression), mood and pain. It is usually tried after non-drug treatments (e.g., physical therapy, music therapy, aquatic therapy, regular scheduling of activities, addressing or minimizing environmental factors such as temperature or noise and social factors such as how to talk to and engage the patient, introducing them to new caregivers or routines) and drug treatments (e.g., antidepressants, analgesics, antipsychotics) have failed.

The challenges with medical cannabis/marijuana are:

  • Finding the right content and potency of CBD/THC
  • Working with a good dispensary and prescribing physician
  • Close monitoring of side effects as they trial different doses, formulations and concentrations of marijuana

There are hundreds of products to choose from but it is best to try a product with higher concentrations of CBD than THC (THC has psychoactive properties). Medical cannabis/marijuana comes in tinctures (oily liquid, best mixed in oily foods or liquids), gummies, chocolates and berries and also topical preparations (topicals might be easier to give, but they might not be as effective due to absorption issues). It will likely require experimenting with different products and doses to find an effective product, and it could be that medical marijuana just won't help.

Side effects to be concerned about include drowsiness, dizziness, possible increased risk for worsening cognition and falls, elation and weight gain (although this may be desirable in some people). Cost (these products are expensive) and access may be issues too. In what we have observed in patients so far, it seems to be helpful for some and not for others and side effects have been mild (so far).

Medical Cannabis Resources