1.2. Describe how commonly used medications affect individuals with dementia

This guide will help you answer 1.2. Describe how commonly used medications affect individuals with dementia.

Many people living with dementia require some form of medication. These drugs aim to improve mood, reduce distress, or slow loss of memory and thinking. The choice and use of medicine depend on the type and stage of dementia. Some drugs treat the symptoms affecting memory and behaviour, while others address health problems common in older adults.

Those supporting people with dementia need to know how each medication works and its expected effects. This knowledge helps provide better care, improves quality of life, and supports the person’s dignity and preferences.

Main Medications Used in Dementia

Several groups of medicines are regularly prescribed for individuals with dementia. These include the following:

• Acetylcholinesterase inhibitors
• Glutamate regulators
• Antipsychotics
• Antidepressants
• Anxiolytics and sedatives
• Medicines for other health problems

Each group works differently and targets specific symptoms or difficulties.

Acetylcholinesterase Inhibitors

These drugs are usually offered to people with mild to moderate Alzheimer’s disease or other types of dementia with ‘Lewy bodies.’ Three main examples are donepezil, rivastigmine, and galantamine.

How They Work

Acetylcholine is a chemical in the brain important for memory and thinking. People with Alzheimer’s may have a shortage of this chemical. Acetylcholinesterase inhibitors stop an enzyme (acetylcholinesterase) from breaking down acetylcholine. This action increases the levels of acetylcholine in the brain.

Effects on People with Dementia

• Improvement in memory and thinking
• Slight slowing of the progression of symptoms
• Greater interest in daily activities
• Better communication, in some cases

Response to these medications can be varied. Some people notice clearer thinking and increased alertness, while others may not experience a great improvement.

Side Effects

• Nausea, vomiting, or diarrhoea
• Loss of appetite
• Muscle cramps
• Drowsiness or confusion (rare)

Side effects are more common at the start or when the dose increases. Starting at a low dose and increasing slowly can reduce these effects.

Glutamate Regulator (Memantine)

Memantine is a type of medicine known as an NMDA receptor antagonist. It is often given to people in the moderate to severe stages of Alzheimer’s disease.

How It Works

Glutamate is another chemical messenger in the brain. In dementia, there may be too much glutamate, which damages cells. Memantine blocks the effects of excess glutamate. This protects brain cells and helps with symptoms.

Effects on People with Dementia

• Improved ability to carry out daily tasks
• Reduction in aggression or agitation
• Reduction in distress or confusion

Some people feel calmer after starting this medication. It does not cure or reverse dementia but can slow worsening symptoms for a time.

Side Effects

• Dizziness
• Headaches
• Constipation
• Tiredness

These side effects are often mild and settle with time.

Antipsychotics

People with dementia may become distressed, aggressive, or experience hallucinations (seeing or hearing things that are not there). When other approaches have not worked, a doctor may prescribe an antipsychotic.

Common examples include risperidone and quetiapine.

How They Work

Antipsychotics balance chemicals called dopamine and serotonin in the brain. These are linked to thoughts, feelings, and behaviour.

Effects on People with Dementia

• Reduction in severe agitation
• Fewer or milder hallucinations
• Lower risk of self-harm or harm to others

Around half of those given antipsychotics experience some improvement. They are only used for short periods and under close supervision, because they can cause serious harm.

Side Effects

• Drowsiness
• Falls due to loss of balance
• Stiffness or tremors
• Stroke (higher risk in those with dementia)
• Worsening memory

These risks mean antipsychotics are not the first option. Doctors weigh the benefits and possible harms very carefully.

Antidepressants

Depression and low mood are common in people with dementia. Antidepressants are sometimes given to lift mood and reduce anxiety. Common ones include sertraline, citalopram, and mirtazapine.

How They Work

Antidepressants balance chemicals linked to mood and emotion. They often act on serotonin, a chemical messenger.

Effects on People with Dementia

• Improved mood
• Reduced anxiety
• Possibly better sleep

People may become more interested in life and social activities. Improvements are often small but important to the person’s wellbeing.

Side Effects

• Nausea
• Drowsiness or sleepiness
• Loss of appetite
• Falls (due to dizziness or sedation)

Some antidepressants can worsen confusion in older people. Regular reviews are important to check ongoing need.

Anxiolytics and Sedatives

People with dementia can experience distress, especially during the night. If other methods (like reassurance or routine changes) have not helped, anxiolytics or sedatives may sometimes be prescribed for a short time.

Lorazepam and diazepam are two examples.

How They Work

These drugs slow down activity in the brain. They help people relax and make falling asleep easier.

Effects on People with Dementia

• Reduced anxiety
• Better sleep in the short term
• Less distress during episodes of agitation

This can make life easier for the person and those caring for them. These drugs are not for regular or long-term use, as dependence and negative side effects become more likely.

Side Effects

• Drowsiness
• Memory problems
• Falls
• Worsened confusion

Care staff should stay alert to changes in behaviour, as these medicines can mask causes of distress.

Prescribing Medicines for Other Health Conditions

People with dementia often have other long-term health problems such as high blood pressure, diabetes, or infections. They may take medicines to control these problems, such as antihypertensives, insulin, antibiotics, or pain relievers.

Effects on People with Dementia

These medicines are vital for overall health. But, the way someone with dementia responds can be different from others.

Key points:

• Confusion may increase if medicines interact
• Some drugs can make memory worse
• Higher likelihood of side effects (e.g. constipation, confusion, falls)
• Risk of not taking medicines as prescribed, because of memory loss

Staff supporting individuals must watch for changes that might mean a medicine is causing harm.

Factors Affecting How Medications Work in Dementia

Several factors affect how drugs work for someone with dementia. These include:

• Age and frailty
• Type and stage of dementia
• Other medical problems
• Number of medicines taken (polypharmacy)
• Ability to swallow pills
• Support system at home or in care

Older people often break down medicines more slowly, increasing risk of side effects. It is important to start with a low dose and check for problems.

Communication difficulties make it harder for some people to report side effects. Careful monitoring is needed.

Importance of Regular Reviews

Medicines should be reviewed every few months with a doctor or specialist nurse. This includes checking:

• Is the medication still helpful?
• Are there any side effects?
• Could a lower dose be better?
• Can any medicines be stopped?

Sudden stopping of some drugs can cause withdrawal symptoms or a sudden return of difficult behaviour.

Family involvement in reviews is often useful, since changes in behaviour are often noticed more by family or staff than the person taking the drugs.

Side Effects and Ways to Support People

Side effects are common with all dementia medications. People with dementia may not be able to describe an upset stomach, dizziness, sadness, or tiredness. Support workers should learn to spot signs such as:

• Changes in walking
• Falls
• Refusing food
• Seeming withdrawn or confused
• Sleep changes
• Skin rashes

If these changes appear after starting a new medicine or changing the dose, report to a nurse or doctor.

Ways to support people:

• Offer drinks regularly, as medicines may cause dry mouth or dehydration
• Help them to eat well, if appetite falls
• Watch how they walk and move, and report any unsteadiness
• Gently check for pain or discomfort the person may not describe
• Encourage a calm routine to lower distress and anxiety

Ethical and Person-Centred Use of Medications

Giving a person medication against their wishes (unless they lack capacity and are at risk) is not allowed. Staff must always:

• Follow mental capacity laws
• Seek consent if possible
• Use the least amount of medicine, for the shortest time necessary

Non-drug approaches (like music, activity, or changes in the environment) are often better for behaviour problems. Medicines are not a cure and should be just one part of care.

Ways to Support Safe Medication Use

• Keep up-to-date, accurate medication records
• Follow care plans exactly
• Store medicines securely
• Check expiry dates
• Help the person to take medicines as prescribed
• Report and record any side effects
• Encourage regular reviews with a healthcare professional

Supporting safe, effective medication use is one of the most important parts of care for someone living with dementia.

Final Thoughts

Commonly used medications can improve life for people with dementia by easing symptoms like memory loss, agitation, or low mood. Their effects differ for each person and change as dementia progresses. Side effects are common and often go unnoticed. Support workers play a key part in spotting problems and helping individuals get the right care at the right time. Putting the person’s needs and preferences first makes care respectful and effective. Always work closely with health professionals and carers to keep the person safe and comfortable.