Dementia Treatment: A Complete Guide

Here are the main types of drugs used to treat the cognitive symptoms of Alzheimer’s and other dementia types.

Cholinesterase Inhibitors

• donepezil (Aricept)
• galantamine (Razadyne)
• rivastigmine (Exelon)
• benzgalantamine (Zunveyl)

When given in the early stages of Alzheimer’s, Lewy body dementia, vascular dementia, or mixed dementia, such as when someone has both Alzheimer’s and vascular dementia, “they’re effective at helping maintain cognitive function for maybe 6 to 18 months,” says Freddi Segal-Gidan, a certified physician assistant at Keck Medicine of the University of Southern California Memory and Aging Center in Los Angeles.

Glutamate Regulators

It’s common, Segal-Gidan says, for a person with dementia to start taking a cholinesterase inhibitor and then, after a year or two, add memantine. But if a person can’t tolerate cholinesterase inhibitors due to side effects like nausea or diarrhea, they might take memantine instead.

Anti-Amyloid Drugs

Anti-amyloid drugs include the following:

• donanemab (Kisunla)
• lecanemab (Leqembi)

But anti-amyloid drugs don’t work for everyone, and healthcare providers are still figuring out how to use them in the most effective way. “There’s a lot we don’t know about these drugs,” says Segal-Gidan, because they are new and the clinical trials that led to their approval had limited durations.

• Maintain a healthy weight. Overweight and obesity are linked to diabetes and cardiovascular disease, which can raise your dementia risk.
• Get physical activity. Staying active can help prevent cardiovascular problems linked to dementia.
• Keep your mind engaged. Mentally challenging activities may help limit cognitive decline, from reading to board games and crafts.
• Socialize regularly. Social isolation and loneliness are linked to cognitive decline, so try to take part in social activities.
• Prioritize sleep. Getting seven to eight hours of sleep each night can help ensure that your body and mind are getting the rest they need.
• Prevent head injury. Since head injuries are linked to cognitive decline, it’s important to take steps to prevent them, such as assessing your home to prevent falls and wearing a seat belt in vehicles.
• Don’t smoke. Smoking raises the risk for stroke and other forms of cardiovascular disease linked to dementia.
• Limit alcohol. Drinking too much is linked to memory loss and may increase your risk of falling.

Nondrug treatments are often beneficial for people with dementia, and can take a number of forms.

Segal-Gidan says that managing medications can be especially challenging for people with dementia, so it’s important to get a system in place to make sure that people take their prescription drugs — from pill management tools to having someone come check on them.

Eventually, needing help with other activities is inevitable for most people with dementia. “Somewhere along the course of the disease, people need help to come into their home, or they need to be moved out of their home to a place where there is help,” says Segal-Gidan.

Other commonly prescribed or recommended nondrug therapies include the following:

• Talk therapy with a mental health counselor or meetings with a support group can help people cope with the emotional challenges of their diagnosis.
• Cognitive behavioral therapy helps people learn strategies that can help counter depression and anxiety.

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• Cognitive stimulation therapy keeps the mind active with themed activity sessions.

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• Occupational therapy helps people develop strategies for simplifying everyday tasks and making their home safer.

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• Palliative care can improve quality of life by suggesting ways to relieve symptoms.

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• Music therapy or aromatherapy can reduce anxiety and help improve mood.

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• Regular conversation and social contact with friends, family, and others benefits well-being. Some people might want to participate in a memory café.
• Activities that a person already likes can continue to provide enjoyment. Some people might want to seek out new activities that are mentally stimulating.

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• Physical therapy to address movement issues through cardiovascular, strengthening, and flexibility exercises
• Speech therapy to help manage problems with voice projection or swallowing

For people with frontotemporal dementia who experience language problems, speech and language therapy may be helpful. The goal of this therapy is to make listening and speaking more effective, and it may involve focusing on certain words or using simpler, shorter sentences.

For many people with dementia, cognitive issues aren’t the only target of treatment. “You’re not just talking about cognition. You’re talking about behavior,” says Segal-Gidan. “Most of the drugs that we use are addressing these symptoms, whether that's depression or anxiety or psychosis.”

In early stages of Alzheimer’s disease, irritability, anxiety, or depression are common. In later stages of the disease, many people also experience aggression, agitation, hallucinations, or sleep disruption.

Treatments for Underlying Issues

• Hearing Loss Hearing loss can make it more difficult to interact with others and may increase the risk for cognitive decline.
• High Blood Pressure High blood pressure is linked to vascular dementia, as well as stroke and other forms of cardiovascular disease linked to cognitive decline.
• High Blood Sugar Elevated levels of blood sugar (glucose) in people with diabetes are linked to a greater dementia risk.

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• High Cholesterol Abnormal cholesterol or triglyceride levels can contribute to vascular dementia.
• Blood Clot Risk If you’re at risk for a blood clot that could cause a stroke or heart attack, you may take medications to reduce this risk.

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Treatments for Mood and Behavior

While mood and behavior changes are common in dementia, it’s important for any prescription drugs addressing them to be carefully considered — and to look at other ways to help reduce distress and otherwise improve the person’s life.

“Even with drugs, nonpharmacological approaches can be very effective” for mood and behavioral issues, says Segal-Gidan.

• Reducing physical obstacles or clutter in the home
• Creating a calm environment without excess noise, glare, or distractions like a television in the background
• Scheduling periods of rest between stimulating events
• Providing a security object like a stuffed animal or blanket
• Checking for issues like pain, hunger, thirst, constipation, a full bladder, or skin irritation
• Remaining flexible and nonconfrontational in interactions with the person

• Antidepressants to treat depression or irritability
• Anxiolytics (antianxiety drugs) for anxiety, restlessness, or disruptive behavior
• Antipsychotic medications for hallucinations, delusions, agitation, or aggressive behavior

Treatments for Sleep Problems

• Maintaining a regular sleep and mealtime schedule
• Getting morning sunlight exposure
• Exercising daily, but not within four hours before bed
• Avoiding alcohol, caffeine, and nicotine
• Maintaining a comfortable bedroom temperature
• Using your bed only for sleep (not for television or reading)
• Having night-lights to feel safe while in bed

• Tricyclic antidepressants
• Benzodiazepines and other sedatives
• Antipsychotic medications

Treatments for Movement Issues in Lewy Body Dementia

People with Lewy body dementia usually develop movement symptoms such as muscle rigidity, a shuffling walk, and loss of muscle coordination. These symptoms may not occur until several years after cognitive symptoms begin.

A medication combining carbidopa and levodopa (Sinemet) can help people who have Lewy body dementia with walking and movements like getting out of bed. But it can cause hallucinations and other psychiatric problems, so it’s typically not used to treat mild symptoms.

• Certain drugs can help treat cognitive symptoms in some forms of dementia, but they cannot reverse or stop cognitive decline.
• Making changes to your routines and your home environment can help reduce frustration and improve quality of life with dementia.
• Drugs and other treatments can help address noncognitive symptoms of dementia like behavioral changes and difficulty sleeping.