Can medication help people with dementia?

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There is no medicine that will reverse dementia. The following are some medicines that may be used to help.

Cholinesterase inhibitors

These include donepezil, rivastigmine and galantamine. They work by increasing the level of acetylcholine. This is a chemical in the brain that is low in people with Alzheimer's disease. These medicines do not affect the brain changes, and are not a cure. However, they may slow down the progression of some of the symptoms in about half of people with Alzheimer's disease.

There is debate as to how much these medicines actually help in the wellbeing and day-to-day care of a person with Alzheimer's disease. Some doctors feel that these medicines give only limited benefit which is not always worthwhile. However, some people may benefit more than others.

In the autumn of 2006 (revised in 2007) the National Institute for Health and Clinical Excellence (NICE) issued national guidance on the use of these medicines. NICE recommended that "donepezil, galantamine and rivastigmine should only be considered as options in the treatment of people with moderate Alzheimer's disease." This was a controversial decision as some people feel that these medicines should be available to people in the mild, early stages of Alzheimer's disease. In particular, the Alzheimer's Society (contact details below) is campaigning for the wider use of these drugs as they believe the decision by NICE is wrong.

If one of these medicines is started it is usual to review the situation after three months to see if it has made any difference. The best length of time to stay on medication is not known. Side-effects such as feeling sick, cramps and diarrhoea may occur.

Memantine

This medicine works by reducing the amount of calcium that gets into certain brain and nerve cells. This may help to slow down the damage to cells affected by Alzheimer's disease. Like the medicines above, this is not a cure. Research studies show that it seems to slow down the progression of the symptoms in some cases.

As it is relatively new, the role of memantine is not yet fully established. It is not routinely prescribed. In the same guidance as for the cholinesterase inhibitor medicines (above) NICE issued advice for the prescribing of memantine. The advice states that "memantine is only recommended as part of clinical studies for people with moderately-severe to severe Alzheimer's disease."

Other medication

A tranquilliser is sometimes prescribed as a last resort for people with dementia who become easily agitated.
An antidepressant may be advised if depression is suspected. Depression is common in people with dementia and may be overlooked.
Aspirin and other medicines to treat the 'risk factors' for stroke and heart disease may be appropriate for some people. Especially those with vascular dementia.
Sleeping tablets are sometimes needed if difficulty sleeping is a persistent problem.

There are several other medicines which have been suggested for the treatment of Alzheimer's disease. These include gingko biloba (a herbal medicine), non-steroidal anti-inflammatory drugs (NSAIDs), vitamin E, oestrogens and statins. However, there is not enough evidence from research trials to currently recommend any of these in the treatment or prevention of dementia. In particular, until recently, it was popular to take gingko biloba as a preventative treatment. However, a large research trial published in 2008 (cited below) seems to have clarified that gingko biloba has little or no effect on preventing dementia.

Research continues and new medicines are being developed which show promise.