Though non-drug measures are usually the first-line approach to address the symptoms of dementia, medications are still important in the treatment of dementia. Presently, there is no cure for dementia. Although slight improvements or stabilisation of symptoms can at times be seen, these ultimately do not cure or prevent the disease or restore mental health. There are, however, drugs that may help improve mental function, mood or behaviour and slow down the symptomatic progression of the disease.
It is important to note that not every medication or combination of medications works for everyone. Each person responds differently to different types of medications. Doctors and pharmacists may need to adjust the course of medication based on the response of the person living with dementia and the feedback from caregivers.
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. An 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 first seeking medical advice.
Medication takes time to take 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 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. It can be prevented 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 cannot drink independently.
- Offer barley, milk, soy milk, tea, coffee, juice, juicy fruits and soups for variety.