Week 9: What are the common medications used to treat dementia?

Written by Dr. Herrmann, MD FRCPC

Lewar Chair in Geriatric Psychiatry

Professor, Faculty of Medicine, University of Toronto

Head, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre

 

Medications for Dementia

As mentioned previously, there are no drugs or treatments that can prevent or cure dementia. At the present time there are only 4 drugs approved in Canada to treat Alzheimer’s disease, and they only provide modest benefit for the symptoms of the illness.

 

Three of the drugs (donepezil, galantamine, rivastigmine) work the same way, and act to increase the amount of a brain chemical called acetylcholine. This chemical or “neurotransmitter” is dramatically reduced in the brains of patients with Alzheimer’s disease and some other dementias including Dementia with Lewy Bodies. These drugs can occasionally improve concentration, memory and other brain functions for short periods of times, though ultimately the disease progresses even with ongoing treatment. They all have similar side-effects which can include upset stomach, nausea, diarrhea, loss of appetite and slowing of the heart rate. A trial of one of these medications is generally recommended for all patients diagnosed with Alzheimer’s disease. 

 

The fourth drug, memantine, works on a different brain chemical called glutamate, which is also effected in Alzheimer’s disease. This drug, used with or without one of the medications above, is generally more helpful in the more advanced stages of the illness. It is well tolerated with few side-effects.

Because up to 90% of patients with Alzheimer’s disease will have some type of emotional or behavioral symptom at some point in their illness, many of these people will require treatment with other drugs. Symptoms such as depression, anxiety, agitation, aggression, hallucinations, and insomnia are all common and are frequently treated with medications like antidepressants, antipsychotics and sleeping pills. There is increasing concern that these medications have limited benefits and can potentially cause significant and serious side-effects.

 

Clearly, there is a desperate need for better treatments and ultimately medications that can prevent the illness before it begins to cause symptoms. There is active research ongoing in these areas.

 

For more information on the medications to treat dementia, please refer to Dr. Herrmann’s Memory Doctor Blog at http://health.sunnybrook.ca/memory-doctor/alzheimers-disease-drugs-effective/