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While there is currently no cure for Alzheimer’s disease, certain medications may help manage symptoms or slow down disease progression. This is meant to provide a high-level overview of symptom management medications. We will discuss disease-modifying medications in the coming weeks.
As the name suggests, medications that address symptoms do not alter the underlying causes of disease or change its progression. Rather, they treat the symptoms associated with Alzheimer’s disease to support a better quality of life.
As Alzheimer’s disease progresses, brain cells are damaged and lost, disrupting communication between nerve cells. This worsens cognitive symptoms like memory loss and a decrease in executive functioning. Symptom‑based medications help remaining brain cells communicate more effectively for as long as possible. This is not a perfect fix; brain cells will continue to die while taking these medications, but they can improve the quality of life of the person living with the diagnosis.
Cholinesterase Inhibitors
Cholinesterase inhibitors treat symptoms of memory loss, thinking, language, and judgment. They work by preventing the breakdown of a chemical called acetylcholine. These medications may modestly improve cognition and daily functioning, and in some individuals may reduce fluctuations or hallucinations. Some common forms of cholinesterase inhibitors are:
- Donepezil, also known as Aricept.
- Galantamine, or Rimanyl/Razadyne.
- Rivastigmine, also known as Exelon.
It is crucial to talk with your doctor before taking any of these medications. Working with your doctor can help manage doses to mitigate side effects.
Anti Depressants (SSRI)
A diagnosis of Alzheimer’s can cause significant changes in a person’s social and personal life, which can lead to depression and anxiety in those living with the disease. Depression and anxiety can worsen attention, memory, and overall cognitive function.
Depression and anxiety are thought to be caused by a lack of serotonin in the brain. Serotonin is a neurotransmitter; it transfers messages between nerve cells. SSRIs, or selective serotonin reuptake inhibitors, increase the brain’s serotonin levels to facilitate communication between cells. Antidepressants may help improve symptoms such as depression, anxiety, irritability, and, in some cases, apathy or disinhibition.
Some common antidepressants prescribed to those living with dementia include:
- Escitalopram
- Sertraline
- Fluoxetine
If you think any of these medications may be valuable to you or your loved one, please contact your primary care physician.
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My husband has been on fluoxetine 10mg for approx. 1 month. His PCP is currently weening him off due to possible side affects of increased agitation and aggressive behavior that have worsened since taking this drug. This drug was not helping him. Mamentine 10mg twice daily prescribed 2 mos ago. His restlessness, and aggressive behavior has worsened since taking both drugs, thus, not sure if his condition is worsening, or perhaps he has a low tolerance for these 2 meds.
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2 Reactions@dlssell My husband took namenda for several months, until his new and improved neurologist took him off of it because it was meant for Alzheimer and she said he def doesn’t have that type. He is markedly better off of it. He is less confused ( but still confused) and he says his balance is better and he feels less foggy. He actually seems better to me. Unfortunately, he still gets annoyed and becomes an a..h…, but he’s better.
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1 ReactionSo good to hear he’s improved…a step in the right direction for sure…thank you for your feedback…the best
Hi @dlssell. You may want to consider connecting with others caregivers in the Caregivers: Dementia Support Group
https://connect.mayoclinic.org/group/caregivers-dementia/
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1 Reaction@dlssell My husband has been on Memantine 10 mg twice daily for several years now. He has had to live with hallucinations, fear and agitation ever since. I just
recently read Memantine can cause both. I wonder why the doctor hadn’t told me that? He
put him on an antipsychotic to try to help, but it hasn’t. I am wondering if he should come off the Memantine? He also wears a Rivastigmine patch. I have known of people who chose not to go with all the medications and their loved ones are doing well…no side effects to deal with. Do the medications really help enough to live with the side effects?
@labrown and @dlssell, you both mention your husbands taking 20mg daily Memantine and having adverse symptoms.
I do not know anything about this drug, but I was specifically curious about dosing because of totally different medications I currently take I had sworn off of previously. Lower doses and frequency changes are what has helped me. You, of course are in different situations than I so I do not want to pretend to recommend doing this, just maybe something to run by doctors.
Here is a summary of the drug, Memantine that you may be totally familiar with by now, but in just in case you are not:
- Mayo Clinic Memantine (Namenda) Overview
https://www.mayoclinic.org/drugs-supplements/memantine-oral-route/description/drg-20067012
@lkbous, you mention your husband’s neurologist took him off Namenda because it is meant for Alzheimer’s and he doesn’t have that type. Are you comfortable, would you explain a bit more about his experience. Why did he start the drug? What information about his condition has been explored/confirmed? How long did it take to notice a difference once he discountined?
@jlharsh I am aware of the benefits of Memantine. The problem is the side effects my husband experiences. He started with a low dose Memantine along with Aricept, but once we realized his body wouldn’t adapt to the Aricept, that was discontinued and the Memantine was increased. The hallucinations, delusions, fears and agitation started then.
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1 Reaction@jlharsh thank you so much..I certainly will.
Thank you so much…I certainly will connect.
@labrown My husband is in moderate to severe Alzheimer’s dementia. Since on memantine and fluroxetine his restlessness and aggression has escalated. I’ll discuss this with his physician this week…hoping to not jave to sedate him. I’m also hoping just to remove both medications to see how he does. He also takes anti-seizure medication…all this due to a head injury.
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