Symptom management is the key to living with Alzheimer’s, and pharmaceuticals can help. There is not yet a cure for Alzheimer’s disease or related dementias, but research has shown that certain medications are effective for relieving symptoms, and may even slow the progression of the illness. This means a person can stay mentally sharper for a longer period of time.
And the number of medications for people with dementia is growing. In June, 2021, the Food and Drug Administration approved the sale of aducanumab (brand name Aduhelm), the first FDA-approved Alzheimer’s drug in almost 20 years. This is a promising development, as drugmakers continue clinical trials that could result in more approved dementia pharmaceuticals over the coming years.
To date, there has not been a published study that offers comparisons of these drugs. Therefore, there is no strong evidence that one medication is superior to another. That said, these medications reduce symptoms in a similar way and changing from one to another likely will not produce remarkably different outcomes.
Follow the links below to learn about prescription medications, supplements, and alternative therapies commonly used to treat dementia. The most commonly prescribed medications for improving cognition and slowing the progression of dementia are cholinesterase inhibitors and memantine. The new drug Aduhelm is an antibody designed to target amyloid-beta, a protein that builds up between cells in the brains of people with Alzheimer’s. Other new drugs in development right now are also amyloid-beta-targeting antibodies.
Cholinesterase Inhibitors – Aricept®, Razadyne® (formerly Reminyl®), Exelon®
Cholinesterase inhibitors are commonly prescribed to individuals with Alzheimer’s disease and other forms of dementia in order to treat the symptoms of the disease. These types of medications may delay the progression of memory and language loss, as well as impaired judgment and thinking. More on Cholinesterase Inhibitors.
Memantine – Namenda®
Memantine, commonly prescribed in the United States under the brand name Namenda, is for people with moderate-to-severe Alzheimer’s disease and vascular dementia. Studies have shown memantine treats symptoms by improving memory, awareness, and concentration. More on Memantine – Namenda.
Namzaric® (Cholinesterase Inhibitor plus Memantine)
Depending on your loved one’s symptoms and stage of dementia, a doctor may prescribe both a cholinesterase inhibitor and memantine, or the drug Namzaric, which combines both in a single capsule taken once per day, providing the benefits of each, described above. Side effects of Namzaric include diarrhea, vomiting, and loss of appetite. Most Medicare Part D and Medicare Advantage plans cover the cost of Namzaric.
Aducanumab – Aduhelm®
Aducanumab (brand name Aduhelm) recently became the first medication for Alzheimer’s disease in almost 20 years to receive FDA approval. Aduhelm is an infusion drug administered in a doctor’s office once per month. It’s designed as a monoclonal antibody that attaches to clumps of amyloid-beta between cells in the brain, and then signals the immune system to attack and clear those clumps. Studies have shown that the drug lowers amyloid-beta levels, slowing the loss of memory and improving general thinking ability for people in early stages of Alzheimer’s disease. More on aducanumab – Aduhelm.
|Alzheimer’s and Dementia Medications Chart|
|Type of Medication||Brand Name||Generic Name||Stages of Alzheimer’s||Taken As||Side Effects||Medicare coverage?|
|Cholinesterase inhibitor||Aricept||Donepezil||All stages||Pill||Nausea, diarrhea, loss of appetite||Yes|
|Cholinesterase inhibitor||Razadyne||Galantamine||Early to mid||Pill or capsule||Nausea, diarrhea, loss of appetite||Yes|
|Cholinesterase inhibitor||Exelon||Rivastigmine||All stages||Pill or skin patch||Nausea, diarrhea, loss of appetite||Yes|
|Memantine||Namenda||Memantine||Mid to late||Pill, capsule or solution||Headache, fatigue, constipation, dizziness||Yes|
|Memantine and Cholinesterase inhibitor combined||Namzaric||Memantine+ Donepezil||Mid to late||Capsule||Nausea, diarrhea, headache, dizziness||Yes|
|Aducanumab||Aduhelm||Aducanumab-avwa injection||Early||Infusion||Swelling and bleeding in brain (ARIA)||Not determined yet|
Individuals with dementia may also be prescribed medications that help deal with difficult behaviors and problems that arise as a result of the disease.
Anxiolytics: Medications used to treat anxiety
Dementia can be frightening and worrying as individuals lose abilities and independence. If the anxiety is mild, it can be managed without medication. For instance, relieving stress through exercise or meditation. However, more severe responses, such as panic attacks and emotional outbursts, may need to be treated with anxiolytics, medications that help calm and relax. More on Anxiolytics.
Antidepressants: Medications used to treat depression
Many individuals with dementia also experience depression. Loss of mobility, interactions with the world, and independence can escalate into loss of appetite, fatigue, and a lack of interest in daily activities. Antidepressants may help improve both mood and function for these people. More on Antidepressants.
Antipsychotics: Medications used to treat psychosis
As dementia progresses, the grasp on the difference between fact and fiction, and real and imagined, blurs. As this happens, people with dementia may have hallucinations or believe that other people are “out to get them.” Sometimes, the person may become agitated, uncooperative, or even hostile. Antipsychotics are prescribed in more serious cases to help manage difficult behaviors when anxiolytics (anti-anxiety medications) may not be enough. More on Antipsychotics.
Hypnotics: Medications used to promote sleeping
Individuals with dementia can also have difficulties getting to sleep or staying asleep. Many of the medications commonly prescribed to dementia patients can fatigue them during the day. This may make it harder for them to fall asleep or to sleep through the night. Some caregivers find it useful to limit the number of naps their loved ones take during the day. If increasing their daily activity does not help, hypnotics may help them find restful sleep. More on Hypnotics.
Acupuncture: A therapy in which thin needles are inserted into the skin, acupuncture is meant to correct the flow of energy, called Qi, through the body along paths called meridians. Studies have shown that acupuncture is as effective for treating symptoms of Alzheimer’s disease as the medications described above.
Massage Therapy: Stimulating blood and lymph flow through the body, massage therapy at least provides physical touch that can help relieve stress, depression, and even pain for people who have Alzheimer’s disease or a related dementia.
Music Therapy: Listening to music for 20 minutes can cause a noticeable improvement in eye contact, talkativeness, and general mood for people with Alzheimer’s disease. Studies have shown, in fact, that listening to music can particularly reduce agitation in people with dementia. For more, including how to make a playlist, click here.
Art Therapy: Making art projects, for example with painting or sculpting clay, has been shown to stimulate senses and relieve stress, creating a noticeable improvement in thinking and mood for people with dementia.
Light Therapy: Sitting beside a bright (10,000 lux) light for 30 minutes to an hour every day has been demonstrated in studies to improve symptoms of dementia, especially related to sleep problems and a disrupted circadian rhythm. Red light therapy, or photobiomodulation, involves wearing small red lights that pulse at a particular frequency (40 Hz) and may stimulate cell healing for improved dementia symptoms, according to studies. More on Bright Light Therapy.
CBD (aka Cannabidiol) is a compound derived from the Cannabis plant that has positive medicinal effects but does not make people feel “high,” or anxious. CBD, in various forms, is legal in 47 US States. Studies have found evidence that cannabinoids such as CBD could help remove dementia from brain cells. However, the US Food and Drug Administration has not approved a CBD drug for treating dementia (though it has approved a CBD-based drug for treating epilepsy).
There are three ways CBD can work to improve health outcomes for persons with dementia: by reducing inflammation, by reducing oxygen buildup, and by working as a brain stimulant and neuroprotectant. From a user’s perspective, CBD may reduce stress and anxiety in the individual with dementia as well as reduce the decline of memory and other brain functions.
Medicare does not cover CBD. More on CBD for dementia and more on CBD specifically for Parkinson’s Disease.
In addition to prescription medications, many individuals with dementia, including Alzheimer’s, use herbal medicine and supplemental nutrition to help treat the disease’s progression and symptoms. Our ability to extract vitamins from food weakens as we age, so supplementing is an easy way to get crucial nutrients into our bodies and promote a healthy brain and nervous system. These supplements are not FDA-approved, and their safety and effectiveness cannot be fully known, but many have demonstrated benefits for people with dementia in smaller studies. Omega 3 fatty acids, for example, contribute to stronger blood flow to the brain and help strengthen cells. Some supplements, like ginkgo biloba, have been used as anti-inflammatory medicine for centuries. Vitamin B1, as another example, increases brain metabolism for possible improvement in memory and concentration.
Supplements are usually pills that provide the nutrition our bodies take from a healthy diet, without having to cook or eat food that your loved one might not like. Often, a normal diet is not enough for us to get the recommended amount of beneficial elements, and supplementing can improve a person’s overall well-being. Because supplements might interact with medications, it’s important to talk to a doctor before putting your loved one on a supplement regimen, but this is a simple way to get your loved one healthier. For much more, including side effects and insurance coverage for these supplements, click here.
In addition to treatments already in use, there are new drugs and therapies in development for treating dementia:
Lecanemab: Another amyloid-beta targeting drug by the makers of Aduhelm (see above), lecanemab (also called BAN2401) reduces the buildup of those plaques between brain cells and may be able to relieve symptoms while slowing the progression of dementia. Lecanemab showed promise in Phase 2 clinical trials, and Phase 3 trials are underway. The FDA recently (in June 2021) granted lecanemab “breakthrough therapy” status, which is meant to speed up the approval process. More on lecanemab.
Donanemab: Yet another drug being developed to target amyloid-beta in the brains of people with dementia is donanemab, which has also received the FDA’s “breakthrough therapy” status, meant to speed the approval process, as Phase 3 trials continue through 2021 and into 2022. Brain scans of subjects who took donanemab have shown a reduction in amyloid-beta, and tests have demonstrated that dementia progresses more slowly for people with dementia who are taking the drug. More on donanemab.
Oligomannate: A drug made from seaweed, oligomannate was recently approved by Chinese regulators to be sold to people with Alzheimer’s disease in that country. Oligomannate works by changing bacteria in our intestines in a way that decreases swelling in the brain. There has long been an association between gut bacteria and brain function, and the drug is intended to strengthen the immune system to improve brain health. Studies in China demonstrated an improvement in dementia symptoms, and Phase 3 trials are currently underway in the U.S. More on Oligomannate.
Others on the Horizon: An anticoagulant (blood thinner) called 3K3A-APC that was being developed primarily for treating brain bleeds after strokes has also been shown to have dementia-fighting properties, reducing plaque in the brain during the early stages of dementia. For mice with Alzheimer’s put into their brains, 3K3A-APC blocks amyloid-beta buildup and relieves symptoms.
Other treatments in the trial phase include using ultrasound waves to safely penetrate the blood-brain barrier that helps brain cells fight infection, allowing for the clearing of plaques that cause Alzheimer’s. The waves can theoretically target precise parts of the brain without damaging surrounding areas, opening the barrier for treatments that previously could not get through. This would allow for better delivery of drugs, enhancing effectiveness and delivering improved outcomes.