Treatment and management of dementia

If you are diagnosed with dementia, your doctor and a specialist, like a neurologist, psychogeriatrician, geriatrician or psychiatrist, will usually be involved in prescribing medications for you.

There is currently no known medication that can cure dementia. But medication can treat some of the symptoms that come with different forms of dementia. They can also help with some of the conditions that come along with dementia, like anxiety and sleep problems.

Questions to ask about medications

When your doctor prescribes a medication for you, here are some questions you can ask:

• How does this medication help?
• How will it take before I notice its benefits?
• What are its side-effects? If I feel those side-effects, what should I do?
• How often should I take it, and how much?
• What should I do if I miss a dose?
• What happens if I need to suddenly stop taking it?
• How will it interact with my other medications?
• Will it affect my other medical conditions?
• When should I come back to check how well it’s working?
• Will it get less effective as my dementia progresses?
• Is it available at a subsidised rate?

Taking medication

Take your medications exactly the way your doctor tells you. Make sure you know the dose, the time of day to take them and if you should take them with or without food.

There are some medicines you can take when you need them. Others need to be taken regularly to help. Ask your doctor which your medication is.

Some medicines take time to work. It might take several weeks for you to feel a medicine working. Your doctor will tell you how long.

If you’re feeling side-effects, especially strong side-effects, talk to your doctor.

Only take medications that have been prescribed to you. Don’t share your medication with anyone else. Make sure medicines are kept safe and secure.

Keep a record of your medications, and any other treatments you’re getting. Take this record when you go to the doctor: it will help them choose the best treatment for you.

There are many different types of dementia, so there are many kinds of medicines used to treat people with dementia.

Here are some of the more common medical treatments for dementia.

Cholinesterase inhibitors for Alzheimer’s disease

Cholinesterase inhibitors are medications that stop important chemicals in your brain breaking down. Those chemicals, which are called acetylcholine and butyrylcholine, help your brain cells communicate with each other.

Cholinesterase inhibitors can help improve your memory and your ability to carry out day-to-day activities if you have Alzheimer’s disease.

Cholinesterase inhibitors may also help with motivation, mood and confidence, and with delusions and hallucinations.

If cholinesterase inhibitor medications are effective for you, they may reduce your need to take other medications. However, in higher doses they may make you feel more agitated or give you insomnia with nightmares.

Cholinergic medications for Alzheimer’s disease

Cholinergic medications work differently to cholinesterase inhibitors. Instead of stopping those important communication chemicals in your brain from breaking down, they either produce more of those chemicals, or they act just like those chemicals, doing the same thing in your brain.

Cholinergic treatments are approved for use for people with mild to moderate Alzheimer’s disease.

It’s possible to receive these medications at a lower price if a doctor or psychiatrist diagnoses you with Alzheimer’s disease.

If you show improvement on a commonly used test of mental function in the first six months of treatment, you may be able to keep getting subsidised medication.

Memantine for Alzheimer’s disease

Memantine is the most recent antidementia medication to be developed.

Memantine targets a different brain chemical, called glutamate, that is present in high levels if you have Alzheimer’s disease. Memantine blocks glutamate and prevents too much calcium moving into the brain cells causing damage.

This may have a positive effect on your mood, behaviour and agitation.

It is the first in a new class of therapies and acts quite differently to the other Alzheimer’s disease treatments that are currently approved for treatment in Australia.

Memantine is the first medication approved for people with middle to later stages of Alzheimer’s disease.

It is available at subsidised rates under the Pharmaceutical Benefits Schedule if you meet the criteria for diagnosis and stage of disease.

Antidepressant medications

It’s very common to feel symptoms of depression when you have dementia. You might experience depression after getting your diagnosis. Later, the effects of dementia on your brain can also cause symptoms of depression.

If you’re feeling depressed, talk to your doctor. They can help in many ways. One way is with antidepressant medication.

Antidepressants can help improve your mood and control the irritability and rapid mood swings that often occur in dementia and following a stroke.

Your doctor will usually prescribe antidepressant medication for at least six months.

Antidepressants take time to work. It can be three to six weeks before you will feel better from taking them. You might feel the side-effects within a few days of starting the medication.

Take your antidepressant medication exactly as your doctor tells you to.

Anti-anxiety medications

Feeling afraid, worried, nervous or stressed sometimes is a normal part of life.

But if you’re feeling very anxious, in sudden attacks or over time, in a way that is too much for the situation and doesn’t go away, you may have an anxiety disorder.

If you feel this way, talk to your doctor. There are different ways to treat anxiety disorders, but one is with medication.

Your doctor might prescribe a medication called a benzodiazepine at first. These are only used for a short time. They are sedatives that help you feel calmer and sleep.

Your doctor might also prescribe an antidepressant medication for your anxiety. This is normal. It can take a few weeks for the antidepressant to start working, and you’ll probably take it for at least six months.

Both kinds of anti-anxiety medication can have side-effects. Talk to your doctor about what you might experience with your medication.

Take your anti-anxiety medication exactly as your doctor tells you to.

Sleep medications

Dementia can change the way you sleep. You may need much more or much less sleep. You might find yourself struggling to get to sleep or stay asleep.

Some dementia medications can also make you drowsy during the day, which makes you less able to sleep at night.

It’s different for everyone, but some form of disturbed sleep is very common in people with dementia.

If you’re struggling with sleep, talk to your doctor. They can give you good advice and treatment, and they might prescribe medications for sleep.

The most common sleep medications are called hypnotics, or sedatives. They help you get to sleep at bedtime.

Taking sedatives can make you confused or unsteady on your feet if you wake up while they’re still working. Some people also experience incontinence while they sleep while using sedatives.

Talk to your doctor about the best sleep medication for you. Take your sleep medication exactly as your doctor tells you to.

Antipsychotic medication

Antipsychotics (also known as neuroleptics or major tranquillisers) are medications that were originally developed to treat people with schizophrenia. The use of antipsychotics in people with dementia remains controversial and clinical trials are in progress to better determine their effectiveness.

Unproven treatments

These treatments have no strong evidence to show they’re effective in treating dementia or its symptoms.

The future of dementia treatment

Trials are in progress assessing benefits of an Alzheimer’s vaccine (having a component of the amyloid protein found in plaques), inhibitors of the enzymes that produce amyloid and therapies using nerve growth factor. These approaches may prove to be effective, but much more work is needed.

Researchers around the world are working to develop effective treatments for dementia, and eventually to find a cure. Much of this work is focussed on Alzheimer’s disease, the most common form of dementia.