Medicines to treat dementia
Most of the medications available are used to treat Alzheimer's disease as this is the most common form of dementia. They can help to temporarily reduce symptoms.
The main medicines are:
These medicines prevent an enzyme from breaking down a substance called acetylcholine in the brain, which helps nerve cells communicate with each other.
Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease.
There is evidence that these medicines can also help treat dementia with Lewy bodies and Parkinson's disease dementia, as well as people who have a mixed dementia diagnosis of Alzheimer's disease with vascular dementia.
There is little difference between these medicines in their effectiveness. However, rivastigmine may be preferred if hallucinations are one of the main symptoms.
Side effects can include nausea and loss of appetite. These usually get better after two weeks of taking the medication.
This medicine (also known as Namenda) is given to people with moderate or severe Alzheimer's disease, dementia with Lewy bodies and those with a combination of Alzheimer's disease and vascular dementia. It's suitable for those who can't take or are unable to tolerate acetylcholinesterase inhibitors. It works by blocking the effects of an excessive amount of a chemical in the brain called glutamate.
Side effects can include headaches, dizziness and constipation, but these are usually only temporary.
Medicines to treat challenging behaviour
In the later stages of dementia, a significant number of people will develop what is known as "behavioural and psychological symptoms of dementia (BPSD)". The symptoms of BPSD can include:
- increased agitation
These changes in behaviour can be very distressing, both for the person with dementia and for the person caring for them. However, there are coping strategies that can help.
If coping strategies don't work, antipsychotic medicines such as risperidone or haloperidol may be prescribed for those showing persistent aggression or extreme distress.
These are the only medicines licensed for people with moderate to severe Alzheimer's disease (risperidone and haloperidol) and vascular dementia (just haloperidol) where there is a risk of harm to themselves or others.
Risperidone should be used at the lowest dose and for the shortest time possible (up to 6 weeks) as it has serious side effects. Haloperidol can be used only if other treatments have not helped.
The decision to prescribe a medicine should be taken by a consultant psychiatrist.
Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.
Some people with dementia and their carers use complementary remedies, such as gingko biloba, curcumin or coconut oil. However, there is not enough evidence to say whether such remedies are effective.
It's best to be wary of any products that claim to benefit people with dementia. If you're thinking of taking such a product or supplement, it's important to consult a doctor first. Some remedies interact with prescribed medicines and they should never be taken as a substitute.
Treatments that don't involve medicines
Medicines for dementia symptoms are important, but are only one part of the care for a person with dementia. Other treatments, activities and support – for the carer, too – are just as important in helping people to live well with dementia.
Cognitive stimulation therapy
Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve:
- problem-solving skills
- language ability
Evidence suggests that CST benefits people with mild to moderate dementia.
This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks.
Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not. In the early stages of dementia, it can help you cope better with the condition.
Reminiscence and life story work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows that they can improve mood and wellbeing. They also help you and those around you to focus on your skills and achievements rather than on your dementia.
You'll find more details about these treatments in the Alzheimer's Society's dementia guide.