Pharmacological Management of Dementia - DementiaHub.SG

Pharmacological Management of Dementia

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Common Medications Prescribed for Dementia

The following are some medications used to relieve some symptoms of dementia:

Acetylcholinesterase Inhibitors

1. Helps maintain mental function
2. Donepezil (Aricept), Rivastigmine (Exelon*) and Galantamine (Reminyl)
3. Used primarily to treat mild to moderate stages of the disease although there is also evidence of effectiveness in advanced dementia
4. * Exelon is available in a patch form to be stuck onto the skin

N-methyl D-aspartate (NMDA) antagonists (which prevent cell damage from glutamate), such as Memantine

1. Alternative if patients cannot tolerate Acetylcholinesterase inhibitors
2. Can be used on its own or in combination with Acetylcholinesterase inhibitors

Antipsychotics, Antidepressants, Mood Stabilisers and Sedatives

1. Used to treat various challenging and disruptive symptoms such as anxiety, depression, aggression, agitation and sleep problems as a result of dementia

Side Effects

All medications have side effects. Consult your doctor or pharmacist on what they are. Do not make adjustments to the medication routine of a person living with dementia without seeking medical advice first.

Medication takes time to take their intended effect, and so it is important to follow the prescription even if effects are not seen for some time and if side effects are present. In addition, effects differ from person to person, so even if other persons respond differently, caregivers and the person taking it should not independently decide to change their dosage.

Generally, the medications listed above are well tolerated. Possible side effects include:

Acetylcholinesterase Inhibitors

1. Nausea, vomiting, diarrhoea

N-methyl D-aspartate (NMDA) antagonists (which prevent cell damage from glutamate), such as Memantine

1. Dizziness, headaches, fatigue, hallucinations, confusion

Antipsychotics

Antipsychotics must be used with caution and usually not for prolonged periods because they can:

1. Increase the risk of cardiovascular diseases, such as stroke or heart attack
2. Cause excessive drowsiness and impair alertness and communication
3. Cause slowness, rigidity, unsteady gait and falls

Hydration

Certain medications can also interfere with feelings of hydration and/ or thirst. Dehydration can be a serious health problem in older adults as it can be associated with other illnesses. Prevent dehydration by providing the person living with dementia with adequate fluids throughout the day.

Tips to increase fluid intake:

• Offer water frequently throughout the day and at mealtimes.
• Offer help to those who can’t drink independently.
• Offer barley, milk, soy milk, tea, coffee, juice, juicy fruits and soups for variety.

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