Medications

Doctors use medicines to treat dementia in the following ways:

• To correct an underlying condition causing dementia, such as thyroid replacement for hypothyroidism, vitamins for lack of vitamin B12, or antibiotics for infections
• To maintain mental functioning for as long as possible when dementia cannot be reversed
• To prevent worsening of vascular dementia from future small strokes in people with high blood pressure and high cholesterol
• To manage depression, insomnia, hallucinations, agitation, and aggression

Medication Choices

Doctors may prescribe the following medicines to help maintain mental function:

• Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon). These were developed to treat Alzheimer's disease, but they may be tried in other dementias to improve or maintain mental function. Recent studies indicate that this class of drugs holds promise for the treatment of people with vascular dementia. Both donepezil and galantamine have been shown to improve mental function with few side effects.^{10, 11} Rivastigmine was also beneficial for people with dementia with Lewy bodies or Parkinson's disease, but side effects such as nausea, vomiting, and weight loss were common.¹² At present, medicines can only slow, not stop, the progress of dementia. It is not clear how long these medicines will work. They may only stop the progress of dementia for a short time.
• Memantine (Namenda). This is a type of medicine that can slow the late stages of Alzheimer's disease. It may also benefit those with mild to moderate vascular dementia.^{13, 12} More studies are under way.

The doctor may prescribe medicines for high blood pressure and high cholesterol, since these conditions are risk factors for vascular dementia.²⁵ These drugs cannot reverse existing dementia, but they may prevent future strokes and heart disease that can lead to further brain damage. For more information, see the topics High Blood Pressure (Hypertension), High Cholesterol, and Transient Ischemic Attack (TIA).

Medicines that doctors may use to help control mood or behavior problems include:

• Antidepressants to treat depression, which is common in dementia. They must be used with caution, because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, for example) and citalopram (Celexa).¹⁴
• Medicines such as risperidone (Risperdal) or olanzapine (Zyprexa), called antipsychotic drugs. Doctors may use these to treat symptoms such as anxiety, agitation, aggression, sleep problems, firmly held false beliefs (delusions), and hallucinations. Antipsychotic drugs are not approved by the FDA for the treatment of dementia. Studies of people with psychosis due to dementia who were treated with these medicines found an increased risk of death. Discuss this risk with your doctor before taking these medicines.

What To Think About

Rivastigmine (Exelon) can now be given through a skin patch. Skin patches release medicine into the blood at a steady level and may reduce side effects. And it’s easier for caregivers to make sure a person is taking the medicine properly when the person uses a skin patch.

The medicines risperidone (Risperdal) and olanzapine (Zyprexa) have been found to reduce behavior problems and psychosis in people with dementia.¹² However, these and similar drugs have some known risks:

• The U.S. Food and Drug Administration (FDA) issued a public health advisory stating that people with dementia who use antipsychotics may die sooner than those who don't use these drugs. Examples of these antipsychotics include haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).
• The makers of Risperdal have issued a warning that older adults taking this medicine may have a slightly higher risk of stroke.

Several new medicines have been studied, including oxiracetam and pentoxifylline. These medicines are experimental and have not yet been rigorously studied for dementias other than Alzheimer's.

Studies have found daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.²⁶

FDA advisory about antidepressants. The FDA has issued an advisory to patients, families, and health professionals to closely monitor for signs of suicidal behavior in adults and children taking antidepressants. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that people taking antidepressants be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. The FDA has not recommended that people stop using antidepressants but simply to monitor those taking the medications and, if concerns arise, to contact a doctor.