1.1. Outline the most common medications used to treat symptoms of dementia

This guide will help you answer 1.1. Outline the most common medications used to treat symptoms of dementia.

Dementia is a term that describes a group of conditions affecting the brain. People with dementia may have problems with memory, language, understanding, and judgement. Over time, symptoms usually get worse. Several types of dementia exist, but Alzheimer’s disease is the most common. Others include vascular dementia, Lewy body dementia, and frontotemporal dementia.

There is no cure for dementia. Treatment aims to ease symptoms and help people stay independent for as long as possible. Both medicines and non-drug therapies may help. The main focus is often on treating memory loss, confusion, changes in mood, and disturbed behaviour.

Always seek professional medical advice before administering medicines.

Why Medications Are Used in Dementia Care

Medications cannot stop dementia or reverse its effects. Some drugs can help with symptoms for a time. These drugs work by changing chemical messages in the brain called neurotransmitters. By helping nerve cells to talk to each other, these drugs may slow the decline in memory and thinking. Medication may also help with mood swings, anxiety, and agitation.

Not everyone with dementia benefits from medication. The decision to use medicines depends on the type of dementia, stage of the illness, and the person’s overall health. Doctors use medicines carefully, and regular reviews assess whether a drug is helping or causing side effects.

The Main Types of Medication Used in Dementia

There are two main groups of drugs used to treat symptoms of dementia:

• Acetylcholinesterase inhibitors
• NMDA receptor antagonists

Other medicines may be used to treat related symptoms like agitation, depression, hallucinations, or sleep problems.

Acetylcholinesterase Inhibitors

This is the most common group of drugs used for Alzheimer’s disease and for some people with dementia with Lewy bodies and Parkinson’s disease dementia. These drugs increase the amount of a chemical called acetylcholine in the brain. Acetylcholine helps messages pass between brain cells.

The main acetylcholinesterase inhibitors prescribed in the UK are:

• Donepezil (brand name Aricept)
• Rivastigmine (brand name Exelon)
• Galantamine (brand name Reminyl)

Donepezil

Donepezil is given once daily, usually in the evening. It is used for mild-to-moderate Alzheimer’s disease. Some people see improvement in memory, attention, and daily functioning. Side effects may include nausea, diarrhoea, loss of appetite, muscle cramps, and sleep problems. These effects are often mild and temporary.

Rivastigmine

Rivastigmine can be given as capsules, liquid, or a skin patch. It is used for mild-to-moderate Alzheimer’s disease and Parkinson’s disease dementia. The skin patch is helpful if someone has trouble swallowing pills or feels sick from tablets. Side effects may include nausea, vomiting, weight loss, dizziness, and skin irritation with the patch.

Galantamine

Galantamine comes as tablets, extended-release capsules, or oral solution. It is used for mild-to-moderate Alzheimer’s disease. People might see improved thinking, concentration, or ability to cope with daily tasks. Common side effects are nausea, vomiting, diarrhoea, loss of appetite, and headache.

When Are Acetylcholinesterase Inhibitors Used?

Doctors usually prescribe these medicines for people in the early to middle stages of Alzheimer’s disease. They may also be given in some other dementias if memory problems are significant or if hallucinations and aggression are a problem.

Not everyone responds in the same way, so doctors review treatment often and may stop the drug if there is no benefit or if side effects cause problems.

NMDA Receptor Antagonists

The main medicine in this group is called memantine (brand name Ebixa). Memantine works differently from acetylcholinesterase inhibitors. It blocks a chemical called glutamate, which can be too active in the brains of people with Alzheimer’s disease.

High levels of glutamate can damage nerve cells. Memantine helps protect nerve cells from this damage. It is usually prescribed for moderate-to-severe Alzheimer’s disease.

Memantine

Memantine can slow the loss of mental abilities and help with problems such as confusion, aggression, and agitation. It is started at a low dose and increased gradually. Side effects tend to be mild and include headache, dizziness, constipation, and sometimes feeling confused or anxious.

Memantine may be used alone or with an acetylcholinesterase inhibitor. Doctors often prescribe it when the illness has become worse and the person can no longer take care of themselves.

Medicines Used for Related Symptoms

Dementia can cause distressing changes in mood, behaviour, and perception. Sometimes, doctors prescribe medications to help manage these symptoms.

Antidepressants

People with dementia often feel depressed or anxious. Antidepressants help improve mood and reduce distress. Common types include:

• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and citalopram
• Mirtazapine

Antidepressants can take a few weeks to work. Common side effects include dry mouth, drowsiness, and constipation. Antidepressants are not likely to make memory problems worse. Doctors avoid older antidepressants called tricyclic antidepressants in people with dementia as they can cause confusion or falls.

Antipsychotic Medicines

Sometimes, people with dementia have hallucinations or behave aggressively. Antipsychotics help reduce these symptoms. They are used only when someone is very distressed or risks harming themselves or others. Doctors are very careful because these drugs can increase the risk of stroke and death in people with dementia.

Common antipsychotics prescribed in dementia are risperidone and, rarely, olanzapine and quetiapine. Side effects may include drowsiness, movement problems, and increased risk of infection. Antipsychotics are only for short-term use when other approaches have failed. Regular reviews are important.

Sleeping Tablets

Many people with dementia have trouble sleeping. Sleep medicines, such as zopiclone or temazepam, may be used in the short term. These are not for long-term use as they may cause falls and worsen confusion.

Medicines for Anxiety and Agitation

Severe anxiety or restlessness may need short-term medication. Lorazepam and diazepam are sometimes used but may cause drowsiness, loss of balance, and increased confusion. These are given at the lowest dose, for the shortest time possible.

Medicines and Types of Dementia

Not all medicines are suitable for every type of dementia. It is important to match the drug to the person’s diagnosis.

• Alzheimer’s disease: most responsive to acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine.
• Vascular dementia: these medicines are not licensed, but may help if the person has a mixed dementia (such as Alzheimer’s with vascular changes). Treating high blood pressure, high cholesterol, and diabetes is also important.
• Dementia with Lewy bodies: rivastigmine and donepezil may be used. Antipsychotics are avoided if possible because they can cause severe side effects.
• Frontotemporal dementia: there is no medicine that improves symptoms. Sometimes, antidepressants or antipsychotics treat behaviour changes.

Side Effects and Monitoring

All medicines carry the chance of side effects. It is important to balance the benefits and problems that drugs can bring. Regular check-ups help spot side effects early. Family members or staff working with the person should look for changes in behaviour, appetite, sleep, or any new symptoms.

Doctors will usually:

• Start at the lowest possible dose
• Increase slowly
• Review often and stop if the drug causes harm or no longer helps

Some signs of side effects include:

• New or worse confusion
• Stomach upsets
• Falls and dizziness
• Heart problems

If side effects appear, the doctor may reduce the dose or try a different medicine.

Key Points for Health and Social Care Workers

Supporting someone taking dementia medication means understanding what each drug does. Workers should know why the person needs the medicine and what signs to watch for. Always record any concerns and report them to a senior or manager.

Tips:

• Always give medicines as prescribed
• Watch for missed doses
• Be alert for new symptoms or side effects
• Encourage the person and carers to talk about how they feel

Some people may refuse medicine. Workers can support by staying calm, explaining in simple terms, and offering reassurance. If someone still refuses, do not force them. Report this to the manager or nurse in charge.

Non-Drug Therapies

Medicine is only one part of dementia care. Talking therapies, activities, routines, and support can help people live well with dementia. Medicines work best alongside person-centred care and a supportive environment.

Special Considerations

Older people are more sensitive to the effects of medication. People with liver, kidney, or heart problems may need a lower dose or a different drug. Always check if medication interacts with the person’s other medicines.

Review medicines regularly. Medicines that once helped may no longer be needed as dementia progresses. Doctors may reduce or stop drugs, especially if side effects outweigh the benefits.

Law, Consent, and Record Keeping

Giving medication is covered by strict legal rules. Only trained and authorised staff may give medicines. Record every dose given, refused, or missed. Gaining consent is important, even if someone lacks capacity. Try to involve the person in decisions as much as possible. Always follow your organisation’s policy.

Final Thoughts

Remember, medication is just one part of care. People with dementia need understanding, patience, and respect. Their families and carers deserve support too. Good communication helps spot problems promptly and keeps everyone involved in decision-making.

Knowing about the main medicines used in dementia can help you support people better at work. Share concerns. Always ask for help or advice if you are unsure about any aspect of medication use in dementia care.