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