What are the medications for dementia?

From the Guidelines

Cholinesterase inhibitors like donepezil, rivastigmine, and galantamine are recommended for mild to moderate dementia, while memantine is recommended for severe dementia, as they can delay clinical decline, benefit cognitive function, and help reduce symptoms such as memory loss and confusion. When considering treatment options for dementia, it's essential to prioritize medications that have shown statistically significant improvements in cognitive function and global assessment of dementia, despite their clinically marginal effects 1. The goal of treatment in dementia is to delay clinical decline, benefit cognitive function, and help reduce symptoms, with medications such as cholinesterase inhibitors and memantine being commonly prescribed 1. Some key points to consider when treating dementia include:

• Cholinesterase inhibitors are generally recommended for mild to moderate dementia
• Memantine is recommended for severe dementia
• The combination of memantine and donepezil is recommended for severe Alzheimer's disease in some countries
• Treatment should be individualized based on the specific type of dementia, stage of disease, other medical conditions, and potential drug interactions
• Regular follow-up with healthcare providers is necessary to monitor effectiveness and adjust dosages as needed 1. In terms of specific medications, donepezil (Aricept, 5-10mg daily), rivastigmine (Exelon, 1.5-6mg twice daily), and galantamine (Razadyne, 4-12mg twice daily) are commonly prescribed for mild to moderate Alzheimer's disease, while memantine (Namenda, 10mg twice daily) may be added for moderate to severe Alzheimer's 1. It's also important to note that these medications don't cure dementia but may temporarily improve symptoms or slow progression, and side effects can include nausea, vomiting, diarrhea, and dizziness 1.

From the FDA Drug Label

Rivastigmine tartrate capsules, USP are indicated for the treatment of mild-to-moderate dementia of the Alzheimer's type (AD). Rivastigmine tartrate capsules, USP are indicated for the treatment of mild-to-moderate dementia associated with Parkinson's disease (PD). Donepezil hydrochloride tablets are indicated for the treatment of dementia of the Alzheimer’s type. Efficacy has been demonstrated in patients with mild, moderate, and severe Alzheimer’s disease. Galantamine Tablets, USP are indicated for the treatment of mild to moderate dementia of the Alzheimer's type.

Dementia Medications:

• Rivastigmine (2) is used to treat mild-to-moderate dementia of the Alzheimer's type and Parkinson's disease dementia.
• Donepezil (3) is used to treat dementia of the Alzheimer's type, with efficacy demonstrated in mild, moderate, and severe cases.
• Galantamine (4) is used to treat mild to moderate dementia of the Alzheimer's type. These medications are approved treatments for dementia, but the specific medication and dosage should be determined by a healthcare professional based on the individual patient's needs.

From the Research

Dementia Medications

• Donepezil is an acetylcholinesterase inhibitor approved for use across the full spectrum of mild, moderate, and severe Alzheimer's disease 5.
• Cholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, have proven efficacy in improving cognition, behavior, activities of daily living, and global functioning in mild-to-moderate Alzheimer's disease 6.
• Donepezil has been shown to improve cognitive performance and stabilize functional abilities in people with mild-to-moderate Alzheimer's disease 7.
• A systematic review and meta-analysis found that donepezil, galantamine, rivastigmine, and memantine are able to stabilize or slow decline in cognition, function, behavior, and global change in patients with Alzheimer's disease 8.
• A meta-analysis of randomized controlled trials found that galantamine is effective in treating all aspects of Alzheimer's disease and is the first choice for the treatment of AD, while donepezil, rivastigmine, and memantine have different effects on AD 9.

Common Medications

• Donepezil: available at doses of 5 or 10 mg once daily, and a single high once-daily sustained-release 23-mg dose for treatment of patients with moderate to severe AD 5.
• Galantamine: effective in treating all aspects of AD, including cognition, function, behavior, and global change 9.
• Rivastigmine: has proven efficacy in improving cognition, behavior, activities of daily living, and global functioning in mild-to-moderate AD 6.
• Memantine: able to stabilize or slow decline in ADAS-cog and ADCS-ADL changes in AD patients, but has no significant effect on other cognitive aspects 9.