Questions To Ask The Doctor If Drugs Are Prescribed
- What are the potential benefits of taking this drug?
- How long before improvement may be noticed?
- What action should be taken if a dose is missed?
- What are the known side effects?
- If there are side effects, should the drug be stopped?
- If the drug is stopped suddenly, what happens?
- What drugs might interact with the medication?
- How might this drug affect other medical conditions?
- Are there any changes that should be reported immediately?
- How often will a visit to the doctor who prescribed the drug be needed?
- Is the drug available at a subsidised rate?
The Top Dementia Medications
Donepezil
Sold under the brand name Aricept, this medication is a cholinesterase inhibitor prescribed to help those diagnosed with mild, moderate, and severe Alzheimers disease. Donepezil is taken as a pill, or dissolving tablet for those unable to swallow, with side effects that commonly include gastrointestinal issues and sleep disruption. First approved by the FDA in 1996, this drug was classified to treat all stages of Alzheimers in 2006 after extensive clinical trials showing its potential to delay the onset of memory loss and cognitive abilities.
Galantamine
This medication is sold under the name Razadyne, and it is a cholinesterase inhibitor that is effective and mild to moderate Alzheimers disease. According to the NIH, the main differences between this medication and donepezil are that galantamine users caregivers recorded less burdens during their patients time on the medication, in a 2003 clinical trial. Both medications have similar amounts of side effects, but galantamine users experience a skin rash sometimes, in addition to the standard intestinal issues caused by the tendency of cholinesterase inhibitors to increase stomach acid production.
Rivastigmine
Tacrine
Taking AChE Inhibitors Long Term
NMDA Receptor Antagonists
Drugs That Can Cause Dementia
While the root of dementia is uncertain and there are no cures for dementia-related conditions like Alzheimers disease, researchers have discovered certain drugs linked to dementia that should be avoided. People who take certain medications are at a higher risk of developing dementia abusing these drugs increases this risk exponentially. Unfortunately, some of these drugs are more commonly used than we think.
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Stopping Or Continuing Anti
Background
Dementia is the term used to describe a group of illnesses, usually developing in late life, in which there is a deterioration in a persons ability to think, remember, communicate and manage daily activities independently. It can be caused by several different brain diseases, but the most common form is dementia due to Alzheimers disease. At the moment, there are no medical treatments which can prevent dementia or stop it from progressing, but there are two classes of drugs the cholinesterase inhibitors and memantine – which are approved and widely prescribed to treat some of the symptoms. They are used mainly for dementia due to Alzheimer’s disease but also sometimes for other types of dementia. Most of the trials studying the effects of these drugs have been quite short even though dementia usually lasts for years. The drugs can have unwanted side effects in some people. There is uncertainty about their long-term effects and about how useful they are for severe dementia, with different countries making different recommendations. Therefore it can be difficult for doctors and patients to decide if and when these drugs should be stopped once they have been started.
What was the aim of this review?
In this review, we aimed to summarise the best evidence about whether stopping cholinesterase inhibitors or memantine was beneficial or harmful to people with dementia who had been taking them for at least two months.
What we did
What we found
Our conclusions
How Is Alzheimer’s Disease Treated
Alzheimers disease is complex, and it is therefore unlikely that any one drug or other intervention will ever successfully treat it in all people living with the disease. Still, in recent years, scientists have made tremendous progress in better understanding Alzheimers and in developing and testing new treatments, including several medications that are in late-stage clinical trials.
Several prescription drugs are already approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. And, on June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.
Most medicines work best for people in the early or middle stages of Alzheimers. However, it is important to understand that none of the medications available at this time will cure Alzheimers.
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Support And Care Is The Most Important Part Of Treatment
When someone is diagnosed with dementia, a full assessment may be suggested to look at their practical skills, their ability to look after themself, their safety in their home, etc. This usually involves assessment by a number of different healthcare professionals. An individual care plan may be drawn up that outlines the person’s specific needs. The aim is to maintain the independence of someone with dementia as much as possible and for as long as possible.
Most people with dementia are cared for in the community. Often, the main carer is a family member. It is important that carers get the full support and advice which is locally available. Support and advice may be needed from one or more of the following healthcare and allied professionals, depending on the severity of the dementia and the individual circumstances:
The level of care and support needed often changes over time. For example, some people with mild dementia can cope well in their own home which is very familiar to them. Some may live with a family member who does most of the caring. If things become worse, a place in a residential or nursing home may be best. The situation can be reviewed from time to time to make sure the appropriate levels of care and support are provided.
Treating The Accompanying Symptoms Of Dementia
Dementia often causes a number of behavioural and psychological symptoms which can be very distressing.
These may include depression, anxiety, sleeplessness, hallucinations, ideas of persecution, misidentification of relatives or places, agitation and aggressive behaviour. These symptoms may respond to reassurance, a change in the environment or removal of the source of any distress such as pain. However, sometimes medication may be required for relief.
Major tranquillisers
Major tranquillisers, also known as neuroleptics or anti-psychotics, are used to control agitation, aggression, delusions and hallucinations. Haloperidol is one commonly used drug. In modest doses this drug tends to cause symptoms similar to Parkinsons disease such as stiffness, shuffling gait and shakiness, and older people are very prone to these side effects. Some are unable to tolerate even low doses of Haloperidol.
Newer tranquillisers such as Risperidone have fewer Parkinsons like side effects and have been studied more intensively in people with dementia than Haloperidol has. Risperidone appears to be helpful for the treatment of aggression and psychosis, but may be associated with a slight increase in risk of stroke.
Olanzapine and Quetiapine are sometimes used, but have been less comprehensively studied in the treatment of dementia, and there is some evidence that Olanzapine may also be associated with increased risk of stroke.
Drugs for treating depression
Drugs for treating anxiety
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Which Common Medications Are Linked To Dementia
Emily Hong & Meg Seymour, PhD
You may have heard the media coverage that common medications may increase the risk for dementia. These medications include a variety of drugs, including antihistamines , some antidepressants, and drugs that help people with Parkinsons.1 What do these drugs all have in common, what do you need to know about them, and are there really risks to taking them?
The drugs in question are called anticholinergic medications. They block the action of a neurotransmitter called acetylcholine. Acetylcholine is important for memory, attention, and learning. Because of this connection to memory and the brain, the side effects of some anticholinergic drugs can include dementia-like symptoms, such as memory loss and confusion.
In most cases, these side effects go away after people stop taking the medications.2 However, people taking some anticholinergic drugs may have an increased risk of developing dementia later.2, 3, 4 It is important to note that there are many types of anticholinergic drugs that treat many conditions. The risk may be specific to some drugs. So, its important to assess each type of anticholinergic drug separately.
A 2019 study conducted in England included 284,343 patients.4 It looked at 56 different anticholinergic drugs to see their effects on risk for dementia. The study found that people had a higher risk for dementia if they took:
- Antidepressants,
What Are Cholinesterase Inhibitors
If your loved one has Alzheimerâs disease that isnât too severe yet, their doctor might prescribe them a cholinesterase inhibitor. If they have another type of dementia, their doctor may consider it, too.
What they do: Scientists think these help prevent a âmessenger chemicalâ in our brains called acetylcholine from breaking down. Acetylcholine is important in learning, memory, and mood. Cholinesterase inhibitors also appear to delay the worsening of Alzheimerâs symptoms.
These medicines include:
What to expect: Most people with Alzheimerâs who take one of these medications get some benefit from it, including less anxiety, improved motivation, and better concentration and memory. And some are able to continue with their regular activities.
But the improvements donât seem to last long — about 6 to 12 months. They mainly delay the worsening of the disease for a period of time.
All three medicines work similarly, but one might work better for your loved one than it does for someone else.
Side effects: Most people donât have side effects when they take cholinesterase inhibitors, but some do have:
- Nausea
- Insomnia
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Medications For Alzheimers: Early To Moderate Stages
In the early to moderate stages of Alzheimers, a class of drugs called cholinesterase inhibitors are used.
These drugs treat symptoms related to memory, thinking, language, judgment, and other cognitive processes.
They might also help delay symptoms or slow them from worsening and may help control some behavioral symptoms. However, they dont always work for everyone.
3 commonly prescribed cholinesterase inhibitors:
- Aricept is approved for all stages of Alzheimers
- Exelon is approved for mild to moderate Alzheimers
- Razadyne is approved for mild to moderate Alzheimers
Side effects include nausea, vomiting, loss of appetite, and increased frequency of bowel movements.
Cholinesterase inhibitors work by affecting certain chemicals that carry messages among the brains nerve cells. As the disease progresses, less of that chemical is produced.
Thats why these medications become less effective over time.
What Are Antipsychotic Drugs
Antipsychotic drugs are used to treat people who are experiencing severe agitation, aggression or distress from psychotic symptoms, such as hallucinations and delusions. They tend to be used only as a last resort, such as when the person, or those around them, are at immediate risk of harm.
For some people, antipsychotics can help to reduce the frequency or intensity of these changes. However, they also have serious risks and side effects, which the doctor must consider when deciding whether to prescribe them.
The first prescription of an antipsychotic should only be done by a specialist doctor. This is usually an old-age psychiatrist, geriatrician or GP with a special interest in dementia.
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What Drugs Are Used To Calm Dementia Patients
Many different drugs are used to calm individuals with dementia and their symptoms, with medication regimens based on the type of dementia each individual has. Some of the most common include painkillers like buprenorphine, antipsychotic medications and benzodiazepines.
There is no cure for dementia and, as a progressive disease, it gets worse over time, often resulting in mood swings, anxiety, anger or other emotions that are hard for individuals and their families to deal with.
But that doesnt mean you have to deal with frustration and other difficult emotions without help. There are many ways to calm individuals with dementia and help them find the support they need for a happy, productive life and ease the stress on their family and friends.
Medication is just one of those techniques, and its often combined with other tools, such as music therapy, to create a calm, positive environment.
Medications For Alzheimers: Moderate To Severe Stages
In the moderate to severe stages of Alzheimers, Namenda is the primary drug prescribed.
It can improve memory, attention, reason, language, and the ability to perform simple tasks.
Namenda can be used alone or with other Alzheimers disease treatments.
People with moderate to severe Alzheimers might also benefit from taking both Namenda and a cholinesterase inhibitor .
3 commonly prescribed drugs at this stage:
- Namenda is approved for moderate to severe Alzheimers
- Aricept is approved for all stages of Alzheimers
- Namzaric
Namenda regulates the activity of glutamate, a chemical involved in information processing, storage, and retrieval.
It can cause side effects including headache, constipation, confusion, and dizziness
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People With Dementia May Be Prescribed Interacting Drugs
- Experts say that older adults with dementia should limit the number of medications they take that act on the brain and central nervous system .
- Using three or more such medications together places an individual at higher risk of adverse outcomes.
- A study finds that nearly 1 in 7 older people with dementia who do not live in a nursing home take three or more of these medications.
- The study examines the prescriptions that doctors have written for 1.2 million people with dementia.
Experts are that people aged 65 years or older should not simultaneously take three or more medicines that target the brain or CNS.
Such drugs often interact, potentially accelerating cognitive decline and increasing the risk of injury and death.
This guidance is especially relevant to people with dementia, who often take multiple pharmaceuticals to address their symptoms.
A recent study involving people with dementia found that almost 1 in 7 of the participants are taking three or more brain and CNS medications, despite experts warnings.
While the United States government regulates the dispensing of such medication in nursing homes, there is no equivalent oversight for individuals living at home or in assisted-living residences. The recent study focused on individuals with dementia who are not living in nursing homes.
The study paper appears in
Commonly Prescribed Meds Could Raise Dementia Risk
MONDAY, June 24, 2019 — Doctors often prescribe anticholinergic drugs for a variety of ills. But a new study suggests stronger forms of these drugs may increase the risk of dementia in older patients.
These medicines include everything from milder medicines such as Benadryl to more potent medicines, such as certain antipsychotics and Parkinson’s meds. They’re used to treat a wide range of other conditions, including depression, chronic obstructive pulmonary disease, overactive bladder, allergies, and gastrointestinal disorders.
Anticholinergic drugs help contract and relax muscles, and work by blocking acetylcholine, a chemical that transmits messages in the nervous system.
But the new British study found that people aged 55 and older who took strong anticholinergic medications daily for three years or more had a 50% increased risk of dementia.
“Our study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinson drugs and epilepsy drugs,” said study author Carol Coupland. She works in the division of primary care at the University of Nottingham.
Anticholinergics are known to cause short-term side effects — including confusion and memory loss — but it’s unclear if long-term use increases the risk of dementia.
There was no increased risk of dementia among patients who took other types of anticholinergic drugs such as antihistamines and gastrointestinal drugs.
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Seizures & Mood Stabilizers
Common Drugs Taken:
- Valproic acid
- Uses: May be used to treating aggression. Has a sedative effect on agitated physical and verbal behaviors.
- Risks and Side Effects: Confusion or worsened thinking, dizziness, difficulty walking or balancing, tremor and the development of other Parkinsonism symptoms, and gastrointestinal symptoms including nausea, vomiting, and/or diarrhea.
- Non-Drug Treatments: Identifying underlying causes, promoting physical and emotional comfort, and changing the environment.
Making A Decision About Treatment
The five Alzheimers drugs are roughly equivalent in their effectiveness, with no clear evidence that any one is more effective than the others. They do differ in the side effects they cause. Cost is also an important factor for many people, and some Alzheimers medications are available as generics, which generally have a substantially lower cost than brand name counterparts .
Of the five available Alzheimers medications, tacrine is ruled out due to the risk it poses to the liver. Your doctor is unlikely to prescribe this drug be cause it has been linked to liver damage. Should it be recommended, we advise a thorough conversation with your doctor about the choice, and a second opinion.
As mentioned earlier, all of the Alzheimers drugs, except memantine , are indicated for treatment early in the course of the disease. Donepezil is the only generic drug specifically approved by the FDA for treatment of middle-stage and late-stage
Alzheimers , although the other medicines are also commonly prescribed for people with later-stage disease.
Namenda is not approved to treat early-stage Alzheimers. Indeed, studies have not shown it to be effective for such patients.
But, again, we emphasize the effectiveness of those two drugs may be marginal at best in most people who try them. If there are no indications of improvement after three months, it is unlikely that there ever will be, so the drug should then be stopped.
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