If someone in your family has been diagnosed with Alzheimer’s or another dementia, chances are that they’ve been prescribed one of the “memory medications,” such as donepezil (brand name Aricept) or memantine (brand name Namenda).
But were they told what to expect, and how to judge if the medication is worth continuing?
I’ve noticed that patients and families often aren’t told much about how well these medications generally work, their side effects, and how to determine if it’s likely to help in their situation.
So in this post, I’ll explain how the four Alzheimer’s medications in wide use work. I’ll also address some of the frequently asked questions that I hear from older adults and families.
If someone in your family is taking one of these medications or considering them, this will help you better understand the medication and what questions you might want to ask the doctors. It’s especially important to understand the pros and cons if finances or medication costs are a concern.
I also have a video discussing this topic, along with newer discoveries in Alzheimer’s care and non-drug related approaches:
Note: This article is about those drugs that have been studied and approved to treat the cognitive decline related to dementia. This is not the same as treating behavioral symptoms (technically called “neuropsychiatric” symptoms) related to dementia, such as paranoia, agitation, hallucinations, aggression, sleep disturbances, wandering, and so forth. Until 2023, there were no drugs FDA-approved to treat the behavioral problems of dementia. The use of psychiatric medications, such as quetiapine and brexpiprazole (Seroquel and Rexulti, respectively), in dementia and is covered here: 5 Types of Medication Used to Treat Sundowning & Difficult Dementia Behaviors.)
4 Oral Medications FDA-Approved to Treat Dementia
FDA-approved medications to treat Alzheimer’s and related types of dementia basically fall into two categories:
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
These help increase the amount of the neurotransmitter acetylcholine in the brain. Acetylcholine helps neurons function well.
- Three such medications are FDA-approved to treat Alzheimer’s in “mild to moderate” stages:
- Donepezil (brand name Aricept)
- Rivastigmine (brand name Exelon); this drug is also available as a patch
- Galantamine (brand name Razadyne)
- Tacrine is a fourth cholinesterase inhibitor which was FDA-approved but is no longer in use due to a much higher risk of side effects
- Donepezil and rivastigmine have also obtained FDA approval for the treatment of more advanced dementia
(For more on what “mild-to-moderate Alzheimer’s disease” means, see “How to Understand the Stages of Alzheimer’s & Other Dementias.”)
Memantine
This is the name of an actual drug rather than a class of drugs, but since it’s the only one available of its type, experts consider it the second category of dementia treatment drug.
- Memantine (brand name Namenda) is FDA-approved to treat “moderate to severe” Alzheimer’s disease
- Memantine is an “N-methyl-D-aspartate (NMDA) receptor antagonist.” It dampens the excitatory effect of the neurotransmitter glutamate in the brain.
Since over-excitation of the neurons has been associated with neurodegenerative disease, memantine is considered a “neuroprotective” drug. Hence it is potentially a “disease-modifying treatment.”
In comparison, cholinesterase inhibitors are considered “symptomatic treatment,” as they affect the function of neurons but not the underlying health of neurons.
In other words: memantine might slow down the underlying progression of Alzheimer’s, even if it doesn’t appear to be helping a person. Cholinesterase inhibitors don’t change the underlying progression of Alzheimer’s, but they can potentially help a damaged brain work a little better.
What about the “new” antiamyloid Alzheimer’s drugs (Aduhelm, Leqembi, and Kisunla)?
As of July 2024, three newer drugs for Alzheimer’s have received some form of FDA approval: aducanumab (Aduhelm), lecanemab (Leqembi), and donanemab (Kisunla). (Note: In January 2024, the maker of aducanumab announced they will be discontinuing the drug by the end of 2024.) These drugs are given as an IV infusion, and require monitoring.
Aducanumab (Aduhelm)
On June 7, 2021, the FDA approved a new drug for the treatment of Alzheimer’s disease, aducanumab (Aduhelm). The approval was controversial, as the FDA’s scientific advisory panel had recommended not approving this treatment. In 2022, Medicare announced limited coverage and essentially will only cover the cost of the drug for those who are in clinical trials and meet certain other criteria.
Aducanumab is an antibody treatment that works by reducing amyloid-beta plaques in the brain. In the studies that led to FDA approval, it was only used in patients who had proven amyloid in the brain on PET scan, and were otherwise in the “mild cognitive impairment” stage or early stage of Alzheimer’s disease.
In studies, aducanumab did seem to reduce amyloid-beta in the brain. However, it’s not yet known if this will translate to meaningful improvements in cognition or if this will delay the progression of Alzheimer’s. (It certainly is not going to reverse or “cure” Alzheimer’s.) Furthermore, serious side effects such as brain swelling or small bleeds in the brain affected at least 10% of patients.
Here is a good overview of the aducanumab controversy: Aducanumab for Alzheimer’s disease?
In January 2024, the maker of aducanumab (Biogen) announced they would be voluntarily discontinuing this drug by the end of 2024. The stated reason was to “reprioritize resources” related to Alzheimer’s treatment.
Lecanemab (Leqembi)
Lecanemab (Leqembi) received approval from the FDA on January 6, 2023. It is another antibody treatment against amyloid-beta, and its Phase 3 clinical trial results were published in November 2022. It is also associated with serious side effects and it’s unclear whether the treatment will meaningfully change the progression of Alzheimer’s, so this approval has also generated some controversy. In July 2023, Medicare announced that it will cover lecanemab provided there is participation “in a qualifying registry with an appropriate clinical team and follow-up care.”
I cover the effects and side effects of Leqembi in this video:
Donanemab (Kisunla)
Donanemab was FDA-approved for the treatment of early symptomatic Alzheimer’s disease on July 2, 2024. It is also an antibody treatment against amyloid-beta, and its Phase 3 clinical trial results were published in July 2023. Similar to Leqembi, Medicare will cover it under special circumstances, including participation in a qualifying registry.
The remainder of this article will focus on cholinesterase inhibitors, memantine, and other options widely available to people with Alzheimer’s and other forms of dementia. I will also explain what is known about these medications for mild cognitive impairment.
Frequently Asked Questions About Dementia Medications
How well do cholinesterase inhibitors work?
This is a topic that has been intensively studied and somewhat debated. Of note, most major studies of donepezil and other cholinesterase inhibitors are industry-funded; only the AD2000 trial was not industry-funded.
Overall, in mild to moderate Alzheimer’s disease, the average benefit seems to be a small improvement in cognition and ability to manage activities of daily living. The effect has been sometimes compared to a few months delay in progression of symptoms. (It is not clear that treatment with cholinesterase inhibitors affects long-term outcomes such as the need for nursing home level of care.)
A 2008 review of the scientific evidence concluded that the effect of these drugs is statistically significant but “clinically marginal.” This conclusion was also reached by a 2018 review of the evidence.
But there’s a catch to consider: studies also suggest that although a fair number of people (30-50%) seem to experience no benefit at all, up to 20% may show greater than usual response. So there seems to be some individual variability in how these drugs work for people.
It may also depend on the type of dementia a person has, with some studies suggesting cholinesterase inhibitors have an effect in many people with Parkinson’s disease dementia, and perhaps also dementia with Lewy bodies.
To date, we have not developed any good ways to tell ahead of time who will respond to these drugs.
So it’s important to follow a person’s cognitive symptoms, and side-effects, once they start taking a cholinesterase inhibitor. If it doesn’t seem to be helping, it’s reasonable to consider stopping the medication after a few months.
How well does memantine work?
In people with moderate to severe Alzheimer’s, memantine seems to provide some benefits, in terms of slowing the deterioration of Alzheimer’s. But again, the benefit overall seems to be fairly modest.
It’s not at all clear that people with mild to moderate Alzheimer’s benefit from memantine; a 2011 review concluded that the scientific evidence doesn’t support this claim. This was confirmed by a 2019 review of memantine for dementia.
Do these medications work for dementias other than Alzheimer’s disease?
These medications have been studied for other forms of dementia, including vascular dementia, Lewy Body dementia, Parkinson’s dementia, and mixed dementia.
Bear in mind that the older people get, the more common it is to have mixed dementia, and the harder it is to make a specific determination of the underlying cause of dementia. In geriatrics, we generally assume there is mixed dementia if people are over age 85. (For more on how common mixed dementia is, see this article about the Religious Orders Study and Rush Memory and Aging Project.)
Studies generally find that cholinesterase inhibitors are associated with modest improvements in symptoms in Lewy Body dementia and Parkinson’s dementia.
A 2021 review of cholinesterase inhibitors for vascular cognitive impairment concluded that there is evidence of “a slight beneficial effect on cognition in people with VCI, although the size of the change is unlikely to be clinically important.” (Of note, the mean age of participants in those studies was 73.)
For memantine, some research suggests it can help with vascular dementia, although the benefits again seem to be quite modest.
The effect of memantine on Lewy-Body dementia and Parkinson’s dementia is less clear, with some research suggesting a small benefit but also reports that some people experience worsening hallucinations and delusions with memantine.
Do these medications work for mild cognitive impairment?
Not as far as we know. The research evidence so far indicates that dementia medications do not improve outcomes for mild cognitive impairment.
However, it remains very common for patients with mild cognitive impairment to be prescribed donepezil (brand name Aricept) or another cholinesterase inhibitor.
In principle, this should be done as a trial, meaning that the patient and clinician decide to “try” the medication, see if it’s helping with memory or other thinking difficulties, and stop if it doesn’t appear to be helping.
In practice, many people with mild cognitive impairment end up taking the cholinesterase inhibitor indefinitely. They may be reluctant to stop, but in other cases, it may be that the prescribing doctor doesn’t get around to checking on whether the medication is helping or not.
For more on mild cognitive impairment, see How to Diagnose & Treat Mild Cognitive Impairment.
What are the side effects of donepezil and other Alzheimer’s medications?
Doctors — including geriatricians — consider these medications to be “well-tolerated.” This means that most people don’t experience more than mild side effects, and serious adverse events are rare.
Side-effects of cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine:
- The most common side effects are gastrointestinal and include nausea, diarrhea, and sometimes vomiting. These affect an estimated 20% of people.
- People tend to adjust to gastrointestinal side effects with time. It helps to start with a small dose and gradually increase. Rivastigmine is also available in a patch formulation, which tends to cause less stomach upset.
- In the oral formulations, donepezil tends to cause fewer side effects than rivastigmine and galantamine.
- Some people also experience dizziness, a slowed heart rate, headaches, or sleep changes.
Side-effects of memantine:
- Dizziness is probably the most common side effect.
- Some people seem to experience worsened confusion or hallucinations.
- Memantine generally seems to cause fewer side effects than cholinesterase inhibitors do.
Is it common to take more than one medication for dementia at the same time?
It’s quite common for patients to be prescribed a cholinesterase inhibitor (such as donepezil) plus memantine.
This “combination therapy” has been studied in people with moderate-to-severe Alzheimer’s, and some research suggests a small benefit compared to treatment with just one medication. However, the benefit again appears to be modest at best.
A study of combination therapy in people with mild-to-moderate Alzheimer’s did not show benefit.
Although there is no good research evidence indicating that combination therapy is beneficial in mild Alzheimer’s, in my experience it’s common for people with mild Alzheimer’s to be prescribed combination therapy. Probably this happens because patients — and doctors — want to try anything that “might” work. In most cases, combination therapy for people with mild Alzheimer’s doesn’t seem to be harmful. But, it’s probably not doing much, other than increasing medication costs.
There is no reason to take more than one cholinesterase inhibitor at the same time.
At what point do you stop dementia medications? We’re not sure it’s making a difference.
Many patients and families feel these medications don’t have much effect. This isn’t surprising, since the research results usually find that the effect in most people is small to non-existent.
As cholinesterase inhibitors are “symptomatic” treatment and not disease-modifying, if there’s no sign of improvement after a few months on the maximum dose, many experts agree that it’s reasonable to stop the medication.
That said, as these medications are well-tolerated by most patients and are unlikely to cause harm to anything more than one’s wallet, it’s common for people to remain on cholinesterase inhibitors indefinitely.
As for memantine, this drug is potentially “disease-modifying.” So it may make sense to continue memantine for a few years, even if no improvement is noted by the clinician or family.
Experts generally agree that there’s not much value in continuing either category of medication once a person has reached the stage of advanced dementia, at which point a person is bedbound, unable to speak, and shows little sign of recognizing familiar people.
Do people get worse when they stop dementia medications?
Research suggests that some patients do appear to get worse after stopping cholinesterase inhibitors.
If this appears to be the case, it’s reasonable to resume the cholinesterase inhibitor.
The discontinuation of memantine hasn’t yet been rigorously studied. An observational study of nursing home residents suggested some worsening after stopping memantine.
A Canadian consortium of experts published guidelines on the deprescribing of dementia medications in 2022.
Do any vitamins help treat dementia?
Vitamin E — which works as an antioxidant in the body — has been studied for the treatment of Alzheimer’s, and may be beneficial.
In 2014, a large study of patients with mild-to-moderate Alzheimer’s disease found that daily treatment with 2000 IU/day of Vitamin E resulted in less functional decline than treatment with placebo, memantine, or a combination of memantine and vitamin E.
Of note, since the study was conducted in the VA (Veteran’s Affairs) health system, most participants were men. And again, the benefit seen was modest.
It is not clear that vitamin E helps for mild cognitive impairment. Always talk to a doctor before trying vitamin E for brain health, as vitamin E can increase bleeding risk in some people.
No other vitamins have been shown to slow cognitive decline in Alzheimer’s or other dementias. In particular, although low vitamin D levels have been associated with a risk of developing dementia, no clinical research has shown that treatment with vitamin D helps people maintain cognitive function.
A study of vitamin B supplementation in the treatment of people with mild to moderate Alzheimer’s disease did not show any benefit. Note that participants in this study had normal vitamin B12 levels at baseline; the very common problem of vitamin B12 deficiency in older adults can cause or worsen cognitive problems.
A practical approach to dementia medications
It’s easy to get a bit lost in the weeds, when it comes to medications to treat the cognitive decline of Alzheimer’s and other dementias.
Overall, these are medications that seem to offer only a little — if any — benefit to most people.
In particular, using these medications is unlikely to help a person with Alzheimer’s remain cognitively well enough to live at home safely, or otherwise provide the type of improvements that families are often hoping for. (The effect of these drugs is just not that strong.)
These drugs are indeed widely prescribed, because patients are usually anxious to do everything possible to preserve their mental abilities, and because doctors want to be able to offer *something*. And most of the time, they don’t seem to harm patients or cause significant side effects.
I think it’s reasonable for people to take or try these medications, as long as they are aware of the evidence regarding the usually modest benefits.
So what should you do about medications, if you or your older relative has been diagnosed with Alzheimer’s or another dementia?
If you have already been on dementia medications for a while:
If you aren’t experiencing side effects, you may want to continue on the medications indefinitely.
But if you are concerned about medication expenses and pill burden, consider a trial of stopping the medication.
After all, the overall benefit of these medications is small. And you can always restart dementia medications if you think the dementia symptoms got worse off the medication.
If you are just starting the dementia journey:
If you are debating whether to start medications for dementia, keep in mind the following points:
- When it comes to oral medications: only cholinesterase inhibitors such as donepezil are FDA-approved for mild to moderate dementia. You should definitely ask questions if a clinician proposes starting memantine during the early stages.
- Cholinesterase inhibitors are for symptomatic treatment and do not alter the underlying neurodegeneration. They provide a modest benefit to some people but many people don’t seem to benefit. We are not yet able to tell ahead of time whose symptoms will improve with these medications.
- A reasonable and careful approach is to work with the doctor on a “trial” of a cholinesterase inhibitor. This means:
- Carefully documenting cognitive symptoms before starting the medication.
- Starting the medication at a low dose, and increasing to a full dose over time.
- Monitoring for side effects, such as nausea, vomiting, or diarrhea. These do usually get better with time. Consider lowering the dose or switching to a patch formulation if the side effects are difficult to handle.
- Working with the clinician to reassess cognitive symptoms after 2-3 months. If no improvement has been noted by the patient, family, or clinician, consider stopping the cholinesterase inhibitor.
Other ways to preserve cognition and brain function in dementia
Here’s the most important thing to keep in mind, when it comes to managing the cognitive decline of Alzheimer’s and other dementias:
Medications are only a small part of the solution.
In fact, there are many non-drug ways to optimize brain function. They work for people who don’t have dementia too, so I’ve listed them in this post: How to Promote Brain Health: The Healthy Aging Checklist Part 1.
If you’re concerned about preserving brain function and delaying cognitive decline, you’ll want to review the ten approaches I cover in the brain health article.
For instance, people often don’t realize that many commonly used medications are “anticholinergic,” meaning they interfere with acetylcholine in the brain and worsen thinking. In other words, these medications essentially have the opposite effect of the cholinesterase inhibitors. Which is not so good for the brain.
In a perfect world, your doctors and pharmacists would notice this problem and stop the anticholinergic medications, or at least discuss the pros and cons with you. But as our healthcare system is still highly imperfect, this may not happen unless you ask for a medication review.
Delirium is another common problem that can worsen dementia and often accelerates cognitive decline. So to manage dementia and delay cognitive decline, it makes sense to learn about delirium prevention.
The bottom line on medications to treat dementia
In short: the medications we currently have available to treat Alzheimer’s disease and other medications may help a little. The main harm people experience will be to their wallets. Don’t expect these drugs to work miracles and consider stopping them if you are concerned about drug costs or pill burden.
And above all, don’t forget to think beyond medications, when it comes to optimizing brain function and delaying cognitive decline in dementia.
This article was first published in 2016. It was reviewed and updated in May 2024.
Cathy says
My husband has been on Aricept for four days and I have noticed short term memory worse. Also, his disposition seems not as pleasant. Does it take a few weeks to show improvement or should we stop med now since short term memory worse?
Nicole Didyk, MD says
It’s always difficult to know if a change observed after starting a new medication is due to the medication or something else. It could just be a coincidence that your husband’s behaviour has changes, or there could be another illness or environment change that is the cause.
I usually start donepezil (Aricept) or another cholinesterase inhibitor at a half dose for four weeks, then increase it to the full dose, then continue for three months before assessing the effect.
If a patient called me with this story, I would advise to try to hang on a little longer to see if the changes are really due to the donepezil or not. It would be unfortunate to stop it too early if that’s the case,
Rein Dekker says
I have an urgent question for your appreciated advice and councel. From 2012 to 2018 I did field work with refugees in the Middle East. That was very demanding and I lost a lot of sleep over it and, on Medical Advice. took low dosage Stillnox/ Diazepam to help me sleep. I retired a year before my contract ended ( I am now 69 years old) because I began to notice memory loss. I have stopped taking it after retirement, I have now read somewhere that my memory loss / beginning Alzheimer might be caused by this prolonged use of Stillnox. I wonder if that is the case and -if so – is there anything I can do about it ????
Nicole Didyk, MD says
Hi again Rein, and I notice that you’ve asked this question of us a few times already.
This is one of the best answers from Dr. K that you might want to review: https://betterhealthwhileaging.net/cognitive-impairment-causes-and-how-to-evaluate/#comment-5927
It seems like this issue is really weighing on your mind and I would suggest that someone in your situation see their family doctor about how to get some help and reassurance. Thanks for following the website and stay well!
Rein Dekker says
THANKS for your advice Nicole.
Rein Dekker says
A question for your advice. From 2012 to 2018 I did field work with refugees in the Middle East. That was very demanding and I lost a lot of sleep over it and, on Medical Advice. took low dosage Stillnox/ Diazepam to help me sleep. I retired a year before my contract ended ( I am now 69 years old) because I began to notice memory loss. I have stopped taking it after retirement, I have now read somewhere that my memory loss / beginning Alzheimer might be caused by this prolonged use of Stillnox. I wonder if that is the case and -if so – is there anything I can do about it? Many thanks for your appreciated council !!
Debbie Peek says
I would like to ask one question about how you deal with something much different Concern about a family member fast tracking your mothers death by not being truthful about the condition of your family member. I was not able to be there for my mother the entire time she was brought home from the hospital under hospice. She was not necessarily dying but if she didn’t rally from her kidney failure do yo a UTI, she might. I was with her the first 5 days and she was doing amazing. Up and walking, appetite back, nurses felt she would be off hospice in a few weeks.
Then my sister took over under duress. She had never been fond of my mother and my mother has always been somewhat afraid of her. She can be very mean to my Mom. But I felt hospice would be watching over her. Within two months? My mother was dead. When I arrived back home and started looking at the meds she was all of a sudden on. I was devastated. My sister had reported that she was showing signs of combative behavior at night. She wouldn’t sleep. She was very confused and didn’t know who people were.,
I then look at meds being prescribed, it’s lorazepam and amitriptyline. The lorazepam was 4 times a day. OMG was my reaction, my mother is so sensitive to med’s one Tylenol Pm is to strong. I even doubted that those behaviors were even happening. The hospice nurse came three times a week and my mother always exhibited these strange behaviors when with my mother.
The physical therapist is saying in his notes that my mom is doing well but daughter is saying she is confused and losing her bladder functions. He is concerned that she is declining so quickly. Then she apparently is complaint of severe arm pain from a very old broken arm injury. Now they have her on a fentanyl patch. Now she is not able to get up is so confused she doesn’t recognize anyone. This nurse seems alarmed and thinks the down hill slide is a reaction to fentanyl because she is also a little shocked at how fast this has happened. The problem is there is more than one nurse and other nurses who are extras and do not have the patient all the time is not in the loop of where she was and where she is now. So she takes her off fentanyl and prescribed Morphine. And has upped the dose of alprazolam to 2 tabs twice a day. I’m not getting any of this info until I’m called and told she wouldn’t be alive in two days.
I fly home immediately and ruin to her bed. She cannot even open her eyes or talk. She tries, she managed to say, I have something to tell you, very garbled, but couldn’t say it. I was sobbing and devastated, they said she was dying if Terminal anxiety. I got some juice in a cup with a straw, she sipped it right up, they were not giving her liquids. I also had fed her chunks of popsicle, she opened her mouth for me and ate it up.
I stayed with her late into the evening, I kept saying she so drugged. Why??? And my sister said she wasn’t she was just dying, I had to go home that night but when I said I was leaving and would be back early, she scrunched her face up like she was in pain, bi kissed her goodbye and she managed to get I love you out.
It was the last words she spoke. She was dead the next morning,
Now that my sister is gone, I found the hospice logs and the day I arrived to her, my sister had written down that she gave her 5 doses of morphine and lorazepam and morphine. Twice she gave her doses when I was away on another room for a few minutes, only one hr apart. She was not in any pain and why would she need to.
Then I looked at the slow progression of her being medicated over two months and she was dead,
My question is this. Do the nurses just take family members word for the behavior. Do they never second guess and just treat accordingly because hospice is about dying. I believe my sister fast tracked my mother to her death, she killed her and used hospice to do it.
Who do I go to to explain their relationship and why I was so afraid to leave her. Now I’m so guilt ridden, she would have been alive a few more years. I want to say something to the hospice nurses but I just don’t know how to handle it,
I’m so sorry it’s this long. Please advise..
Debbie
Nicole Didyk, MD says
I can understand feeling guilt and deep grief over what happened, and I’m sorry you had such an awful experience.
When an older adult is in a hospice or on a palliative care plan, there is usually frequent assessment and charting in order to track symptoms and responses to medications. Sometimes family members are asked to monitor and log symptoms as well, and a nurse or physician can give instructions based on what’s reported, but it would be unusual for this to not be integrated with a plan to have the medical professionals do their own assessments. It really depends on the resources that are available and the family’s capacity to manage things at home.
There can be major fluctuations in alertness and communication as people are at the end of life. Sometimes a delirium can be a part of the picture, which produces lucid periods alternating with confusion and drowsiness or restlessness. And many of the medications used to relieve symptoms at end of life can have sedating side effects.
With a loss like the one you’ve experienced, I would recommend getting support and counselling, and many hospices have such resources for families. I wish you healing and peace.
robert moore says
I was wondering has there been any research on using CBD for those suffering with dementia?
Nicole Didyk, MD says
Surprisingly, there haven’t been very few well designed clinical trials of cannabis in those with dementia. This systematic review of the evidence (Cochrane Review)was not very enthusiastic, but that was 2009 and there have been a few additional studies since then.
Nonetheless, there are many people in my practice wondering about its effect on responsive behaviours in dementia. The Canadian Agency for Drugs and Technologies in Health has put out this review, which concludes that we need more research to be confident in prescribing cannabis for dementia symptoms.
One of the challenges, at least in Canada, is that cannabis preparations are very inconsistent from batch to batch, such that a person might get stabilized on a certain dose, and then when they open a new vial, they have to recalibrate the dose to get the same effect.
Overall, CBD in particular seems to be safe and well tolerated in those with dementia, and may be worth a try.
Jade says
Professionals should quit giving people false hope about these useless Alzheimer’s drugs. The only thing they are good for is lining Big Pharma’s pocket. There is no drug ever made or near to be put on the market that has ever worked at all for preventing or reversing or even slowing down this awful disease. Everyone needs to know this.
Nicole Didyk, MD says
It’s true that the medications we have for Alzheimer’s are not miracle drugs, but they can have modest benefits in reducing symptoms, and for some that’s a meaningful result. You’re right that they do not slow progression or reverse the disease, and I’m hopeful that we may have more effective medications in the future.
Brenda says
My husband was diagnosed 11 years ago and was put on Aricept and Memantine and it seem to help for a long time, but now he has severe numbers of BM’s and he doesn’t know his son or any of us. He’s short term and long term memory are gone. I’m sorry but he doesn’t really know anything. He still goes to the bathroom by himself (thank God) and feeds his self. His Dr. Took him off his medicines and put him on Seraquel. Do you think this was a good idea? Thank you
Nicole Didyk, MD says
Thanks for sharing your story, Brenda and I’m so sorry that your husband is living with dementia. Typically, the effect of the cognitive enhancers is modest and doesn’t last forever, so your story is a common one.
Generally, the cognitive enhancer drugs can be stopped if there’s no more meaningful benefit, or if the side effects are intolerable ( and may include diarrhea). The quetiapine (Seroquel) is a medication that we try to avoid in older adults living with dementia, unless we think the person would have a better quality of life on it (like if they are struggling with hallucinations or delusions that are very distressing), and then we try to use the lowest dose possible for the shortest time possible.
Mikey Beach says
My doctor was very candid with me for my mother’s dementia diagnosis at age 79. He told me all the drugs on the market today for Alzheimer’s and dementia are basically worthless !They can come with bad side-effects,usually help very little,some may worsen the condition,and those that may improve it slightly only last a short time and afterwards make it worse ! So really,what’s the point ?
Nicole Didyk, MD says
I don’t know if I would call the drugs we use to treat Alzheimer’s disease “worthless”, but it’s true that for most people the benefits are modest and are probably apparent for 1 – 2 years. The most common side effects are related to nausea, diarrhea and loss of appetite. About 5-30% of people who try the meds have to stop them because of these side effects.
Treatment of dementia is more than just medication. As a geriatrician, I advise trying medication in addition to getting more education, staying physically active and planning ahead. You can watch my YouTube video about it here.
Paul Hofferber says
I am a 68 year old male with diabetes and neuropathy of my feet. I had read online that lithium would help my neuropathy. So I began taking 120 mg of lithium orotate daily. It did not help. But after about three weeks I began to notice memory improvement. I work as a security guard and would have people come back in asking if I remembered them coming in. I didn’t. But after the lithium I started remembering them. My general overall memory recall has gotten very good. I did not even realize that my memory had diminished. But I should have suspected it as I had two aunts, two uncles, a fraternal grandmother, and a maternal grandfather with Alzheimers.
I was talking with an 80 year old friend and told him about my experience. He told me he was having a problem recognizing faces. He started taking 120 mg of lithium orotate daily. He now has no problem recognizing faces and his general memory recall is now very good. His wife was so impressed she has started taking it even though she has no memory problems.
It is well known now that the brain has neuroplasticity. Could lithium facilitate this? Is the brain substituting aluminum (another metal) for a lack of lithium in patients with alzheimer’s in the tangles that are formed? My research on the internet showed some studies that lithium does play a role in neurogenesis.
Nicole Didyk, MD says
Thanks for sharing your interesting story.
From my quick reading, lithium orotate is a supplement that can be purchased over the counter, and the dose you mention would have about 5 mg of elemental Lithium per tablet. Most people who take prescription Lithium are on about 300-900 mg a day of Lithium carbonate. So the dose in the Lithium orotate tablet is extremely small.
Most of the study of Lithium orotate was back in the 1970’s, but lately there has been some discussion about whether Lithium is an important “trace element” and could be neuroprotetive. The level of scientific evidence we currently have is such that I would not recommend taking Lithium orotate for any particular reason.
Nitesh Budhlani says
Hello Dr Leslie,
My mother is suffering from Vascular Dementia/Alzheimer’s from the past 6 years.
She is taking Admanta and Aricept regularly.
As she is having agitated behavior , the doctor prescribed Qutan 25(Quetiapine)- 1 tab daily.
Is it ok to take Qutan 25(Quetiapine) as from what I read online, it has severe side effects for dementia patients.
Leslie Kernisan, MD MPH says
I explain the use of antipsychotics such as quetiapine in this article: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
Normally we would consider this type of medication only after exhausting other options, since there are indeed side-effects and risks. If we decide to try this medication, I usually start at an even smaller dose, which is 12.5mg. Good luck!