Dementia Medications
Information on this website is only educational and all medical advise should come from your personal medical provider.
Some medications may result in an elder appearing to have dementia… but really it is the medication effect, NOT the disease of the elder! No elder should be evaluated for dementia if they are taking sedating meds or meds causing confusion… like Tylenol PM or Zyrtec, or Xanax, or Keppra, or Detrol, or Cymbalta or…
There are no medications to cure dementia. However, we know that avoiding alcohol, cigarettes, eating a plant-based diet, and exercising daily as well and minimizing medications that increase the risk of dementia or make elders look like they have dementia is a good first start.
What is the best medication for dementia?
Cholinesterase Inhibitors
When it comes to minimizing progression of dementia, medications like Donepezil, Rivastigmine, and Galantamine are commonly prescribed to help improve memory, reasoning, and daily functioning. These drugs, known as cholinesterase inhibitors, boost choline, which the nerve cells use to communicate.
They can modestly help improve memory and for some decrease delusions in about 30% taking these meds. They also come with potential side effects. Elders may experience nausea, dizziness, diarrhea, poor appetite or changes in heart rate, making it important to fully understand how each medication might affect you or your loved one.
To explore the details of these treatments, including how they work and what to watch out for, click here to learn more.
Glutamate Drugs
Memantine (Namenda) affects how nerves absorb glutamate, another chemical that helps brain cells communicate. It’s thought that in Alzheimer’s patients, brain cells take in too much glutamate. This may lead to an overstimulated state that makes the cells die.
Some studies have shown that prescribing donepezil and memantine together may be more effective than donepezil alone. Memantine’s use is controversial because it may leave patients oversedated or confused. I have had some patients benefit from this medicine. For many, however, this medicine doesn’t help or it can make them sedated or confused. There is no reason to buy the more expensive combination pill Namzaric (donepizil/memantine) unless your insurance does cover it.
Meds that Decrease Stroke Risk
Aspirin (81 milligrams) thins the blood and decreases risk of recurring stroke, with the risk of bleeding somewhere else, such as from the stomach, or a fall which may result in a more serious head injury and bleeding. It is more cost-effective than any other medication. The biggest side effect of thinning the blood is that it increases the risk of bleeding—mostly in the stomach, but sometimes from injury as well, such as bleeding in the brain after a fall. This risk can be decreased with a proton pump inhibitor (PPI) like omeprazole (Prilosec), which is the most common and inexpensive. However, the PPI can lead to low vitamin B12 absorption as well as increased risk of pneumonia or antibiotic-associated diarrhea that is caused by the bacterium Clostridioides difficile (C Diff). Studies now show that for many elders, aspirin increases the risk of bleeding more than it helps prevent stroke. Work with your neurologist.
Aspirin generally shouldn’t be used with clopidogrel (Plavix), a drug used to prevent blood clots. If an elder has a stent keeping a heart artery open, clopidogrel is used since it is stronger than aspirin. However, aspirin and Plavix have a much higher risk of bleeding particularly in the those who have lost safety awareness and are impulsive. Those with risks of falls are more likely to fall and bleed in their head than have a cardiac event.
Clopidogrel (Plavix) is more effective than aspirin in preventing strokes and is used when a stent is placed in an artery. It has the same risks, and should not be used with aspirin. However, some medications used to protect the stomach, such as omeprazole, esomeprazole (Nexium), and pantoprazole (Protonix) may prevent the clopidogrel from working. Further, clopidogrel may cause excessive bleeding. There’s no quick way to reverse this side effect. Aggrenox, a combination of aspirin and dipyridamole (Persantine), may be used for those with peripheral vascular disease.
Warfarin (Coumadin) is an older blood thinner than is affected by Vitamin K, so drinking alcohol, taking Naprosyn, eating more vegetables will all affect the amount of blood thinness. I have had a few elders almost die because their blood was much too thin. It is crucial to check levels (blood test) often, especially with changes in diet, meds and illness. It is more effective in preventing stroke in atrial fibrillation and heart valve replacement. Today, it is less frequently used to reduce the occurrence of strokes. This is particularly true with those who have atrial fibrillation of the heart, blood vessel narrowing, or replaced heart valves. Those taking it need to be monitored closely for blood thinness and a significant bleeding risk.
Apixaban (Eliquis) is a strong blood thinner, easier to use (no blood test). Often used for the same indication as warfarin, and much more expensive. Caution for these two medications for elders with dementia, poor balance and poor safety awareness; head trauma and serious bleeds are more of a risk. It should not be combined with other blood thinners. It is powerful and increases the risk of bleeding with falls and fractures.
Alcohol and pain medications such as aspirin, ibuprofen (Advil), and naproxen (Naprosyn, Aleve) may thin the blood even more when used with other blood thinners. If a patient has already become confused and falls frequently, the risk of increased bleeding is probably more of a danger than the risk of stroke.
Alzheimer’s Disease Medication
Anti-Amyloid Antibodies for Alzheimer’s disease.
- Aducanumab
- Lecanemab
- Donanemab
I will discuss them as a class, since the names change pretty quickly. Abducamumab was the first, it was found to decrease the amount of amyloid found on scans, and improved neuropsychological testing a few points. However, it cost $56,000/pt /year. The side effects included brain bleed and increased risk of death. The FDA had approved it, which was a deviation from prior policy requiring significant clinical effects to justify increased risk of harm.
It was eventually pulled from the market and several newer medications, including Lecanemab have been introduced… to the same fanfare.
A study published Jan. 5, 2023, in The New England Journal of Medicine looked at 1,795 people who had amyloid plaques in their brains (as confirmed by MRI) and mild memory problems. The researchers found that compared with people taking an inactive treatment, those who took lecanemab for 18 months had a slightly slower rate of cognitive decline (as measured by cognitive tests) and less amyloid in their brains. However, they did not see that it improved overall daily functioning, shopping, banking, driving and other independent activities of daily living.
Lecanemab is administered every other week via an hourlong infusion. It is currently unknown whether a person must take it indefinitely. The drug’s main risks are brain swelling and brain bleeding, which are serious and for myself, will therefore not prescribe this med, since the functional benefit is so small.
Studies have also demonstrated that eating a plant based diet, avoiding processed refined (junk and fast) food and exercising at least 30 minutes daily, as well as minimizing alcohol to a couple drinks a week, and stopping smoking (anything), can decrease the risk of heart attack , stroke and dementia by 40%.
Side effects are minimal (beyond the occasional pizza craving – once a month should be OK). Older adults do need to make sure they get enough protein ( about the size of a deck of cards), best is fish, nuts, legumes. Cheese, milk and animal meats have been associated with increased risk of heart attacks, strokes, dementia and cancers. Veggies are also cheaper than steak.
Exercise, if it were a pill, would be more expensive than Viagra. Really. Studies show that just increasing exercise can decrease the risk of stroke, heart attack and dementia by 20%. Weight bearing exercise can decrease the risk of osteoporosis, improve sleep, digestion, balance, strength and decrease risk of falls.
Ozempic and other SGLP1 diabetes meds are touted as the next cure for Alzheimer’s. The mechanism is that it delays stomach emptying so it decreases appetite, which leads to eating less and weight loss. It is the weight loss that leads to decreased risk factors for diabetes, high blood pressure, high cholesterol, heart attack, stroke, dementia and several cancers.
Since over 80% of Americans are overweight or obese, it can be helpful. But should be a last resort. The side effects include the risk of renal damage from dehydration, from diarrhea, or nausea, vomiting, or hemorrhagic pancreatitis as some of the major side effects.
My mother had frontal dementia in her 60s…. so what do I do? I eat a plant based diet, not vegan, but lots of whole grains and veggies, minimize alcohol (but have wine with a special meal) and work to go walking or biking 30 min most days…. not all. I will not be signing up for the Anti-Amyloid AB shots. The risk is too high for the benefit.
Then I keep connected to friends, I just joined a women’s group and met new people, and now have a group to keep me active. As we age, it is important to keep connected. Actually, the most important risk factor to decrease the risk of dementia and chronic illness is having important relationships and staying engaged. We can all do that. We can help elders in our community to do that.
Medications to Treat Behaviors in Dementia
Ativan
Below is Dr Landsverk’s take on the use of Ativan as outlined in Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer’s and Other Dementias which can be purchased through our site from the link above.
‘One in eight Americans is treated with a med in this class. It is like a shot of vodka, helps at the moment, causes problems later. Treating the behavioral symptoms of dementia remains controversial … Paradoxically, this has resulted in the common prescription of anti-anxiety drugs like lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin) for people with dementia. While tranquilizers like these may yield short-term results—improved behavior for a few weeks—they’re highly addictive. If used for more than a few days in elders with dementia, the withdrawal syndrome often leads to delirium or worse behavior in elders. ’
To learn more about the side effects of Ativan on your loved one Click here
Haldol
The following is from Dr Landsverk’s new book: Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer’s and Other Dementias
‘This may help with delirium in the hospital, but has many serious side effects and rarely is a good choice long term. Haloperidol (Haldol), an older medication, we rarely use it. While it oftens alleviate delusions, hallucinations, and paranoia, it causes [negative] side effects in 30 percent of those treated… restlessness, walking problems, and general stiffness. This medication should also be avoided in patients with Parkinson’s disease; it is dangerous in that the person can become immobile…effects often linger even after the drug is discontinued.’
Read more about how Haldol affects your loved one
Tramadol
The following is from Dr Landsverk’s new book: Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer’s and Other Dementias
‘Some medical professionals believe that if a patient doesn’t complain about pain, there is no pain. Unfortunately, elders with dementia may not be able to identify the source of their distress. When those with dementia hurt, they may act out or they may become withdrawn. It is a mistake to treat agitation from pain (such as distressing arthritis or musculoskeletal pain) with a sedative…rather than with pain-control measures…’
If you’re looking for more information about how Tramadol affects Dementia Patients Click Here
Xanax
The following is from Dr Landsverk’s new book: Living in the Moment: Overcoming Challenges and Finding Moments of Joy in Alzheimer’s and Other Dementias
‘This is the ‘Crack of the Suburbs’, twice as powerful as Ativan and shorter acting, so it is more addictive. No one should take it long term. If used for more than a few days in elders with dementia…[drugs like Xanax] can remove inhibitions, cause paranoia, and increase confusion and falls…they often cause more problems than they solve. Tolerance and addiction from these drugs start to produce more agitation, poor sleep, or confusion. That leads to an increased dose…which increases the withdrawal symptoms, which leads to another increased dose. It becomes a vicious cycle.’
Learn more about the effects of Xanax on Dementia Patients