Is Adderall (amphetamine and dextroamphetamine) used to treat dementia?

Adderall is Not Recommended for Dementia Treatment

Adderall (amphetamine and dextroamphetamine) is not an approved or recommended treatment for dementia and should not be used as a primary treatment option for dementia symptoms. 1

Current Approved Treatments for Dementia

The standard pharmacological treatments for dementia include:

• Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) - recommended for mild to moderate dementia 1
• Memantine - recommended for moderate to severe dementia 1
• Combination therapy (cholinesterase inhibitor plus memantine) - provides cumulative benefits in moderate-to-severe Alzheimer's dementia 1

Limited Role of Psychostimulants in Dementia

While Adderall is not indicated for dementia, there is limited evidence regarding the use of psychostimulants in specific dementia-related conditions:

• Methylphenidate (not Adderall) has shown some benefit for apathy in dementia patients, though the magnitude and duration of effect remain unclear 2
• Psychostimulants as a group have shown little to no effect on cognition in dementia patients 2
• The American Psychiatric Association practice parameter notes that stimulants may be used at lower doses than those used for ADHD in very specific circumstances:
  • For apathy due to a general medical condition following brain injury 1
  • For severe psychomotor retardation in medically ill patients 1

Risks of Using Adderall in Elderly Dementia Patients

Using Adderall in elderly dementia patients carries significant risks:

• Cardiovascular effects - increased blood pressure and elevated heart rate 2
• Psychiatric adverse effects - irritability, agitation, and potential psychosis 2
• Drug interactions - particularly dangerous with MAO inhibitors 1
• Contraindications - including psychosis, glaucoma, and liver disorders 1

Recommended Approach for Behavioral Symptoms in Dementia

For behavioral and psychological symptoms of dementia (BPSD), the recommended approach is:

1. Non-pharmacological interventions first 1, 3:

   • Establish predictable routines
   • Use orientation tools
   • Implement structured activities
   • Reduce environmental stimuli
   • Investigate underlying causes (pain, UTIs, medication side effects)

2. Pharmacological options (when non-pharmacological approaches fail) 1, 3:

   • For psychosis/agitation: Low-dose atypical antipsychotics (risperidone, olanzapine, quetiapine) with careful monitoring
   • For depression/anxiety: SSRIs (citalopram, sertraline)
   • For cognitive symptoms with behavioral impact: Cholinesterase inhibitors and memantine

Important Considerations

• Antipsychotics should only be used when symptoms are severe, dangerous, or cause significant distress 1
• Any medication should be used at the lowest effective dose for the shortest duration 3
• Regular medication review and consideration of discontinuation is essential 3
• Careful patient selection is critical, especially in older adults with cardiovascular disease 2

Conclusion

While limited research exists on psychostimulants in dementia 4, the evidence does not support using Adderall for dementia treatment. The potential risks outweigh any theoretical benefits, and established treatment protocols using cholinesterase inhibitors, memantine, and carefully selected antipsychotics (when necessary) remain the standard of care.