Understanding Medications Used in Dementia: What Families Should Know
- Team Writer
- 22 hours ago
- 4 min read
When someone you love is living with Dementia, questions about medications often come quickly: Is there anything that can slow this down? What helps with memory? What about agitation or hallucinations? Are these medications safe?
The answers depend on the type of Dementia and the symptoms a person is experiencing. While no medication cures Dementia, some treatments can modestly slow progression in certain forms of Alzheimer’s disease, and others can help manage symptoms that affect quality of life.
Let’s walk through what families should know.
Medications That May Slow Alzheimer’s Disease
In recent years, new treatments have become available for people in the earliest symptomatic stages of Alzheimer’s disease — specifically those with 1) mild cognitive impairment (MCI) due to Alzheimer’s or mild Alzheimer’s Dementia, and 2) confirmed amyloid buildup in the brain.
Two FDA-approved medications — lecanemab (Leqembi®) and donanemab (Kisunla®) — are designed to reduce amyloid plaques in the brain. Clinical trials show they can modestly slow cognitive decline, though they do not stop or reverse the disease. These medications are given by intravenous infusion and require careful monitoring, including regular MRI scans.
A key risk is something called ARIA (amyloid-related imaging abnormalities), which may involve brain swelling or small bleeds visible on MRI. In rare cases, ARIA can be serious.
These treatments are not appropriate for everyone and require evaluation by a specialist. Families considering them should have detailed conversations about eligibility, risks, benefits, monitoring, and cost.
Medications That Help With Memory and Thinking
For many years, the mainstay of Dementia treatment has been medications that help with symptoms — particularly memory and thinking.
Cholinesterase Inhibitors, which include Donepezil (Aricept®), Rivastigmine (Exelon®), and Galantamine (Razadyne®)
These drugs increase a brain chemical called acetylcholine, which helps with memory and learning. They are commonly used in:
Alzheimer’s disease
Dementia with Lewy bodies
Parkinson’s disease Dementia
Sometimes mixed Dementia
These medications may provide modest improvements or stabilization in memory, attention, and daily functioning for a period of time. Common side effects can include nausea, diarrhea, decreased appetite, weight loss, dizziness, and in some cases slowed heart rate. Because of this, regular follow-up with a healthcare provider is important.
Memantine (Namenda®)
Memantine works differently: it helps regulate a brain chemical called glutamate, which, in high amounts, can damage brain cells. It is typically used in moderate to severe Alzheimer’s disease, sometimes along with donepezil. It may help with cognition and daily functioning. Side effects are generally mild but can include dizziness, confusion, and headache.
It’s important to remember that these medications do not stop disease progression. Instead, they may help maintain abilities for a time.
Differences Across Dementia Types
Not all Dementias respond the same way to medications.
Lewy Body Dementia and Parkinson’s Disease Dementia
People living with Lewy body-related Dementias, including Dementia associated with Parkinson's disease, often respond particularly well to cholinesterase inhibitors, especially for cognitive symptoms and sometimes hallucinations. However, they can be extremely sensitive to certain medications, particularly older antipsychotics such as chlorpromazine (Thorazine) and haloperidol (Haldol). These drugs may worsen movement symptoms or cause severe reactions.
Medication decisions in Lewy body Dementia require extra caution.
Vascular Dementia
There is no medication proven to slow vascular Dementia specifically. The most important treatment approach is aggressive management of vascular risk factors such as high blood pressure, diabetes, cholesterol, and stroke risk.
When Alzheimer’s pathology is also present (mixed Dementia), Alzheimer’s medications may still be helpful.
Frontotemporal Dementia (FTD)
In FTD, memory medications generally do not help and may sometimes worsen behavior. Instead, selective serotonin reuptake inhibitors (SSRIs), which are antidepressant medications, are commonly used as the first-line pharmacological treatment for behavioral symptoms in Frontotemporal Dementia (FTD), particularly the behavioral variant (bvFTD). These medications, such as sertraline (Zoloft), are generally safe and well tolerated in older adults, and can be beneficial for mood, impulsivity, irritability, or compulsive behaviors.
Managing Behavioral and Psychological Symptoms
Agitation, anxiety, depression, hallucinations, sleep disruption, and paranoia are common in Dementia. Before turning to medication, it’s essential to look for underlying causes:
Pain
Infection
Constipation
Medication side effects
Environmental stress
Hunger, dehydration, or poor sleep
Non-drug approaches are always the first step.
When medication is needed:
Antidepressants (especially SSRIs) may help with depression, anxiety, or irritability.
Sleep medications should be used cautiously.
Brexpiprazole (Rexulti®) is FDA-approved specifically for agitation associated with Alzheimer’s Dementia.
A Word About Antipsychotics
Antipsychotics are sometimes prescribed for severe agitation, aggression, or psychosis. However, families should be aware of significant risks. The FDA has issued a boxed warning stating that antipsychotics increase the risk of death in older adults with Dementia-related psychosis. They are also associated with increased risk of stroke, sedation, falls, worsening confusion, and movement side effects.
Because of these risks:
They should be used only when symptoms are severe or dangerous.
The lowest effective dose should be used.
Treatment should be regularly reassessed.
Attempts to reduce or stop the medication should be made when possible.
In Lewy body Dementia, extreme caution is required. Families should feel comfortable asking:
What symptom is this medication targeting?
What benefits should we expect?
What are the risks?
When will we reassess?
The Bottom Line
No medication cures Dementia. Some treatments may modestly slow early Alzheimer’s disease. Others help manage symptoms that affect safety and quality of life. Medication decisions should always be individualized, regularly reviewed, and paired with non-drug strategies and strong caregiver support.
If you have questions about Dementia medications, talk with your healthcare provider or a Dementia specialist. Knowledge helps families make informed, confident decisions.
Sources
U.S. Food & Drug Administration (FDA). Approval announcements for lecanemab (Leqembi®), donanemab (Kisunla®), and brexpiprazole (Rexulti®).
National Institute on Aging (NIA). “How Is Alzheimer’s Disease Treated?”
Alzheimer’s Association. “Medications for Memory, Cognition & Behavior.”
British Association for Psychopharmacology. Guidelines for anti-Dementia drugs.
New England Journal of Medicine. Trial of pimavanserin in Dementia-related psychosis.
JAMA Neurology; BMJ. Studies on antipsychotic risks in Dementia.
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