Current Pharmacological Treatments for Dementia by Rebecca Bori, RN

What Are Common Medications Used for the Treatment of Dementia?

There are currently 5 drugs that are approved by the Food and Drug Administration (FDA) to specifically treat dementia. They are:

donepezil (Aricept)

galantamine (Razadyne)

rivastigmine (Exelon)

tacrine (Cognex)

memantine (Namenda)

Click HERE for a video on medications used to manage symptoms of dementia.

What Do These Medications Do To Manage The Symptoms of Dementia?

The first four medications listed above all belong to the same classification of medicine, called anticholinesterase inhibitors. They all function similarly by acting on certain neurotransmitters in the brain. Memantine, an NMDA receptor antagonist, is the most recently approved drug to treat dementia and works differently than the others mentioned. However, none of these medications has been proven to “cure” dementia, as it was mentioned previously that dementia is incurable. The purpose of these medications is to ease symptoms and slow down the decline of an individual’s mental status.

How Effective Are These Medications?

The effectiveness of these pharmacological treatments for dementia is questionable. Studies have shown that compared to those who take a placebo—or “fake” pill—most of those who take these medications do not show much improvement or a meaningful delay in the worsening of symptoms. In fact, according to a team of researchers, it has been calculated that for every three to seven people, only one will benefit from taking these medications.

What Are the Common Side Effects of These Medications?

All medications come with a risk of undesirable side effects. Cognex, for example, has been shown to cause liver damage and should therefore be avoided. It is now prescribed very rarely, seeing as that half of the individuals who took Cognex developed abnormal liver functions. Because the benefits of the other four medications are limited, their side effects may outweigh those benefits. Some of the relatively minor side effects that will usually go away in time are nausea, diarrhea, insomnia, and headaches. The potentially severe side effects may include a slow heartbeat, sudden weight loss, lack of appetite, yellowing of skin, and persistent dizziness. It is worthy to note that about 20-25% of dementia patients will stop taking these medications because of side effects.

Should You or A Loved One Take These Medications?

Choosing whether or not to try these medications calls for the consideration of many different factors, especially because of the small benefits these drugs offer. Many newly diagnosed dementia patients will be strongly motivated to maintain brain function and independence, thus taking the gamble of using one of these medications. In early stages, these drugs may indeed delay decline, but as the disease progresses, the benefits of the medications may begin to disappear. Always consult with your doctor about treatment options, as they are most familiar with your individual case and will have the best answers for you.

Are there other pharmacological options to manage the symptom of dementia?

To help in controlling some of the behaviors associated with dementia, doctors will sometimes prescribe other medicines such as antipsychotics, antidepressants, and anxiety medications. If used appropriately, these medications may be helpful. Antipsychotic drugs have been shown to help ease aggressive outbursts, agitation, and hallucinations, but just as any other medication, it can come with side effects. These may include weight gain, diabetes, and even an increased risk of death.

         

It is difficult to choose a medication that will guarantee a benefit to a patient with dementia due to evidence indicating that most people will not benefit from their use. The decision to pursue avenues of treatment for dementia can be overwhelming for the patient and their family. Keeping in mind cost, side effects, and limited effectiveness, there may be other non-pharmacological interventions that can bring about better results with less risk. It is important to acknowledge that medicine is just one component of care; non-medical treatment and psychological support are just as significant in the care of individuals with dementia. Again, always consult with your doctor about treatment options, as they are most familiar with your individual case and will have the best answers for you.

Reference

1. Consumer Reports (2012). Treating Alzheimer’s disease: surprising facts about the effectiveness and safety of these commonly used drugs. Retrieved from http://www.consumerreports.org/cro/2012/07/evaluating-drugs-to-treat-alzheimer-s-disease/index.htm