There is no cure for dementia, so in a best case scenario, medications that are currently available are only able to slow the rate at which the symptoms progress.
Four out of the top five dementia medications are Acetylcholinesterase inhibitors, also referred to as AChE inhibitors:
- Donepezil (Aricept)
- Galantamine (Razadyne)
- Rivastigmine (Exelon or the Exelon Patch)
- and Tacrine (Cognex)
These dementia medications prevent the dissolution of a brain chemical called acetylcholine. People with dementia tend to have lower levels of acetylcholine, a chemical which is essential for proper brain function in the areas of reasoning and memory.
Donepezil is sold under the brand name Aricept. This dementia medication comes in the form of a tablet and is taken once per day, usually at bedtime. If insomnia or other sleep disturbances occur, the option of switching the dose to mornings should be discussed with the doctor. Other side effects can include nausea or diarrhea. Donepezil is usually started at a low dose which is then increased gradually if necessary. This dementia medication is generally not a good choice for people with cardiac problems, asthma, or COPD.
Razadyne is the most-used brand of galantamine. This dementia medication comes in tablet, liquid, and time-released capsule form. As a liquid or tablet it is taken twice daily, while the capsule is a once-per-day dose. This dementia medication often causes an upset stomach, so it should be taken with a meal. It is also important that plenty of water is consumed throughout the day.
While donepezil and galantamine are dementia medications most often prescribed for Alzheimer’s patients, rivastigmine is typically the choice for those with Parkinson’s disease. It comes in oral form, and it is also available as a transdermal patch. The brand name for rivastigmine is Exelon or Exelon Patch. The patch greatly reduces the incidence of nausea and vomiting, the most common side effects of this dementia medication.
Tacrine, sold under the brand name Cognex, was the first AChE inhibitor used to treat the progression of dementia. This dementia medication must be taken four times a day, and often the gastrointestinal side effects are not well tolerated.
Taking AChE Inhibitors Long Term
AChE inhibitors should be taken indefinitely once they are started, as studies have shown that sudden discontinuation of this type of dementia medication can cause a dramatic and irreversible drop in cognitive functioning. In addition to gastrointestinal upset, side effects can include dizziness, headaches, and loss of appetite. AChE inhibitors continue to be an effective way to slow the progression of dementia, but their degree of effectiveness depends in part on how advanced the dementia is when treatment is begun. They work best when they are prescribed for mild to moderate cases.
A Fifth Approach to Dementia Medication: NMDA Receptor Antagonists
People with more advanced dementia can benefit from adding another kind of dementia medication to their regimen: an NMDA receptor antagonist such as memantine, which is sold under the brand name Namenda. This drug prevents the over-stimulation of certain receptors in the brain and can improve the capacity to perform normal daily activities. It can be taken once or twice per day, and is prescribed in conjunction with AChE inhibitors. The most common side effects are headaches and dizziness.
Other Less Targeted Dementia Medications
Other types of medications, such as antidepressants and anti-anxiety drugs, may also be prescribed to treat some of the problems that typically accompany dementia. The use of a variety of pharmaceutical treatments can go a long way toward keeping dementia sufferers at home with their families for as long as possible, despite the fact that fine tuning the different medications can sometimes seem like a juggling act.