When a parent, partner, or loved one is diagnosed with dementia, it's important to find a physician who provides appropriate treatment recommendations and understands the importance of supporting both you as the caregiver and the person living with dementia. Our Director of Clinical Services, Archie McAlexander, suggests following "first do no harm" and "start low, go slow" for families who are seeking treatment options.
Here is a list of the most commonly prescribed medications used when treating dementia and its associated behaviors. This is not an all-inclusive list.
Amyloid-Targeting:
Leqembi (lecanemab) - infusion that is given over 1 hour every 2 weeks.
- Thought to work by targeting harmful amyloid proteins in the brain, commonly seen in Alzheimer's dementia, and by reducing any existing brain plaque.
- One of the newest medications that have been approved by the FDA in the treatment of certain types of Alzheimer's dementia which include mild cognitive impairment due to Alzheimer's disease or other forms of dementia.
- Only utilized after further testing reveals amyloid brain plaque. Those tests include cerebrospinal fluid (CSF) test, amyloid positron emission tomography (PET) scan (a PET scan produces detailed 3-D images of the inside of the body, in this case, the brain), or completing a blood-based biomarker test. Medication will not be recommended until one of these 3 tests is completed.
Cholinesterase Inhibitors:
These medications support communication between nerve cells in the brain. With Alzheimer's, communication between brain cells is slow, meaning the synapses in our brain are not appropriately "firing," which causes a slowing in processing information. When an individual first begins to take these medications, there is potential to see an overall increase in cognitive function. These medications are prescribed to assist in maintaining certain aspects of what can be lost with dementia. One misconception about these medications is that once they "stop working" they should be discontinued. If that is something being discussed with you as the caregiver, please ensure you are asking more questions to understand the physician's reasoning as there is documented proof that when these medications are stopped, significant, rapid decline can occur.
The medications within this group include:
- Aricept (Donepezil): tablet
- Exelon (Rivastigmine): tablet or patch
- Razadyne (Galamantine): tablets
Glutamate Regulators:
This medication is used to assist the brain in processing information and maintaining the ability to perform simple tasks. It can be used alone or in combination with Aricept, Exelon, or Razadyne. It is typically added to the current treatment regimen when an individual is experiencing symptoms of moderate to severe dementia. A similar misconception with this medication type, as with the cholinesterase inhibitor, is if it "stops working" it should be discontinued. Again, if that is something being discussed with you, as the caregiver, please ensure you are asking more questions to understand the physician's reasoning as there is documented proof that when these medications are stopped, a significant, rapid decline can occur.
The medication within this group is: Namenda (Memantine)
Cholinesterase Inhibitor + Glutamate Regulator:
Due to the noted success of combo therapy in the treatment of dementia, the FDA approved the combo medication, Namzaric, which is a combination of Donepezil and Memantine. This medication is an extended-release formulation meaning it is utilized once daily in the treatment of moderate to severe dementia.
Treating Non-Cognitive Symptoms in Dementia:
Dementia can affect more than just your memory or thinking. A person living with dementia may be impacted by behavioral and psychological symptoms are known to accompany dementia which include, but are not limited to, insomnia (sleep disturbance), agitation, hallucinations, and delusions. While there are medications that can assist in treating non-cognitive symptoms, it is important as the caregiver, we try to understand the potential cause of the symptom or the behavioral expression and attempt to address it prior to adding medications.
Some medications you may see utilized to assist in treating non-cognitive symptoms have not received FDA approval for those living with dementia but were observed during studies to benefit those experiencing similar symptoms. These medications are required to carry a safety warning that the medication has been associated with an increased risk of death in older adults with dementia-related psychosis. The "off-label" medications do offer benefits, but it's important that the benefits and risks are discussed prior to being prescribed.
The only 2 medications that have full FDA approval for use in those living with dementia experiencing specific non-cognitive symptoms include:
- Belsomra - used to treat insomnia/sleep disturbances.
- Rexulti - used in treatment of agitation and aggression (known to assist in mood/emotion stabilization)
The following medications are used "off-label" for treatment of non-cognitive symptoms associated with dementia:
- Olanzapine (Abilify): antipsychotic medication, treats behavioral expressions, especially agitation and aggression.
- Quetiapine (Seroquel): antipsychotic medication, treats behavioral expressions, especially agitation and aggression.
- Risperidone (Risperidal): antipsychotic medication, treats behavioral expressions, especially agitation and aggression.
- Lorazepam (Ativan): antianxiety medication, treats anxiety and restlessness.
- Alprazolam (Xanax): antianxiety medication, treats anxiety and restlessness.
- Valproic Acid (Depakote): treats behavioral expressions, especially agitation and aggression.
- Sertraline (Zoloft): antidepressant medication, can help with treating behavioral expressions (like agitation and aggression) or assist in stabilizing a person's mood /emotions.
- Escitalopram (Lexapro): antidepressant medication, can help with treating behavioral expressions (like agitation and aggression) or assist in stabilizing a person's mood /emotions.
- Duloxetine (Cymbalta): antidepressant medication, can help with treating behavioral expressions (like agitation and aggression) or assist in stabilizing a person's mood /emotions.
- Citalopram (Celexa): antidepressant medication, can help with treating behavioral expressions (like agitation and aggression) or assist in stabilizing a person's mood /emotions.
- Trazadone: antidepressant medication, used to assist in the treatment of behavioral expressions and can be used to assist in treating sleep disturbances (as it does assist in shutting down the brain, which allows a resident to sleep.)
- Mirtazapine (Remeron): antidepressant medication, utilized for triple effects, treats behavioral expressions, assists in treating sleep disturbances, and can be utilized to assist as an appetite stimulant (as one of the side effects is the medication can help you feel hungrier, which is beneficial for a person living with dementia whose appetite begins to decrease.)
- Melatonin: treats insomnia/sleep disturbances, naturally produced within our body but can be taken as a supplement to assist in falling/staying asleep. Melatonin is not recommended by most neurologists for those living with dementia due to significant side effects of increased somnolence (wanting to sleep), mood changes, and having the opposite effect (depending on how the medicine is broken down)
At Commonwealth Senior Living, our Resident Care Directors complete comprehensive assessments to determine the best options to provide personalized support. As a reminder, don't be afraid to ask questions and advocate for what is best for you or your loved one.
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By Archie McAlexander
Director of Clinical Services