Receiving a dementia diagnosis can bring up many questions, and one of the first you'll likely have is about treatment. While there is no cure, medications can significantly help manage symptoms and slow cognitive decline. Understanding these options is the first step toward making an informed choice for yourself or a loved one. Here is a clear guide to the most common medications available and how they work to improve quality of life.

Cholinesterase Inhibitors: Boosting Brain Power?

This is the most common class of medications prescribed for mild to moderate Alzheimer's disease. These drugs work by preventing the breakdown of a brain chemical called acetylcholine, which is crucial for memory and learning. By keeping acetylcholine levels higher, these medications help improve communication between nerve cells in the brain. The goal is to stabilize or slightly improve cognitive symptoms, such as memory loss and confusion, for a period of time. Common examples include:

• Donepezil (Aricept)


• Rivastigmine (Exelon)


• Galantamine (Razadyne)

While these medications don't work for everyone, they can provide a meaningful benefit for many, often slowing the progression of symptoms. It's important to be aware of potential side effects, such as nausea, vomiting, or diarrhea, which your doctor will help you manage.

Memantine: How Does It Help Moderate to Severe Symptoms?

Memantine (Namenda) works differently from cholinesterase inhibitors and is typically prescribed for moderate to severe Alzheimer's disease. Instead of boosting a chemical, it helps regulate glutamate, another important brain chemical. In dementia, excess glutamate can damage brain cells, and memantine helps block this toxic effect. By doing so, it can help improve daily function and may allow a person to maintain their independence for longer. It can be used alone or in combination with a cholinesterase inhibitor.

Side effects of memantine are generally mild but can include dizziness, headaches, or constipation. This medication provides an important option, especially for those in later stages of the disease or who can't tolerate other drugs.

Newer Medications: Targeting the Underlying Disease

Inrecent years, the medical landscape for dementia has been shifting with the introduction of new drugs that target the underlying biology of Alzheimer's disease itself. For example, medications like lecanemab (Leqembi) and donanemab are designed to target and clear amyloid plaques in the brain, which are one of the hallmarks of the disease. These treatments are typically for people with early-stage Alzheimer's and may slow the rate of cognitive decline. These are often administered via infusion, and their use requires careful monitoring for potential side effects, such as brain swelling or bleeding. Your doctor will determine if you are a candidate for these therapies based on specific diagnostic criteria and your overall health.

Treating Behavioral Symptoms: Managing More Than Just Memory

Dementia affects more than just memory; it can also cause behavioral and psychological symptoms like agitation, aggression, anxiety, or depression. While non-drug approaches are always the first choice, medications can be used when these symptoms become a safety risk or cause significant distress. These may include:

• Antidepressants: Used to treat depression, which is common in people with dementia.


• Antipsychotics: Used with extreme caution for severe agitation or psychosis, as they have significant side effects.

Your doctor will use the lowest effective dose for the shortest duration possible, with regular monitoring, to manage these symptoms and improve quality of life.

Making an Informed Choice

Finding the right medication plan is a collaborative effort between you, your doctor, and your caregiver. Medications work differently for everyone, and it may take time to find the right balance. It's crucial to discuss all your options, including potential side effects and what you can realistically expect from each treatment. Remember that medication is just one part of a comprehensive care plan, which should also include lifestyle adjustments, cognitive and physical exercises, and a strong support system. By staying informed and working closely with your healthcare team, you can take a proactive role in managing dementia and living life to the fullest.