What meds should dementia patients avoid?

Which Medicines Treat Dementia?

When someone you care about has dementia, their memory loss is affecting their daily life. You want to find a medication that can help them. There are medicines that can help.

What Is Aducanumab-avwa (Aduhelm)?

This is the first drug approved by the FDA to treat Alzheimer’s disease in decades. If your loved one is in the early stages of Alzheimer’s disease, the most common form of dementia, their doctor may prescribe this monthly infusion.

What it does: It’s a monoclonal antibody that lessens the buildup of things called amyloid plaques in your brain. These plaques are part of what leads to the memory loss associated with Alzheimer’s disease.

What to expect: For people with mild cognitive impairment (MCI) or early Alzheimer’s disease, the drug appears to slow down the progression of Alzheimer’s disease.

Side effects: The most common appears to be something called ARIA: amyloid-related imaging abnormalities. One study suggests that 41% of people who take this drug will develop ARIA. These problems include temporary swelling in the brain and small areas of bleeding.

What is lecanemab-irmb (Leqembi)?

This drug is also approved to treat the early stages of Alzheimer’s disease. It may be prescribed as an infusion administered every two weeks.

What it does: It’s a monoclonal antibody that lessens the buildup of amyloid plaques in your brain.

What to expect: For people with mild cognitive impairment (MCI) or early Alzheimer’s disease, the drug appears to slow down the progression of Alzheimer’s disease.

Side effects: In addition to possible flu-like symptoms, patients may also develop ARIA. There is also the possibility of temporary swelling in the brain and small areas of bleeding.

What Are Cholinesterase Inhibitors?

If your loved one has Alzheimer’s disease that isn’t 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 “messenger chemical” 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 Alzheimer’s symptoms.

These medicines include:

Donepezil (Aricept)
Galantamine (Razadyne, Razadyne ER, Reminyl)
Rivastigmine (Exelon)

What to expect: Most people with Alzheimer’s 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 don’t 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 don’t have side effects when they take cholinesterase inhibitors, but some do have:

Nausea
Vomiting
Loss of appetite
More frequent bowel movements
Bruising
Muscle cramps
Headaches
Fatigue
Insomnia

What Is Memantine?

If your loved one has moderate to severe Alzheimer’s, their doctor may prescribe them memantine (Namenda) for their symptoms.

What it does: Memantine could help improve memory, attention, reasoning, and language. Your doctor may also prescribe it with donepezil (Aricept).

Memantine helps balance glutamate, which is another “messenger chemical” involved in our memory and learning.

What to expect: Studies show that memantine can curb delusions (believing things that aren’t true), hallucinations (seeing things that aren’t there), agitation, aggression, and irritability. It can also help your loved one with disorientation and make their daily activities easier.

Memantine comes in immediate-release tablets, extended-release tablets, and oral drops.

Side effects: The side effects aren’t as bad or as common as the side effects of cholinesterase inhibitors, and include:

Constipation
Dizziness
Headache
Confusion
Fatigue
Increased blood pressure
Sleepiness

Taking Oral Medications

For a person with Alzheimer’s, taking medication by mouth can be a challenge. For example, they might not recognize that a pill in their mouth is medicine and that they should swallow it. If this happens, you could ask their doctor or pharmacist if it comes in liquid form or in tablets that dissolve.

If your loved one finds it hard to swallow a pill, there may be a physical reason. For example, if their mouth is dry, have them drink a little water, juice, or coffee first.

If that doesn’t work and the medicine doesn’t come in another form, ask the doctor or pharmacist if you can crush tablets or caplets, or open capsules and sprinkle the pellets into food or liquid. But you shouldn’t do this with medicines that dissolve over time, called sustained-release medications, so be sure to check first.

Managing Medications

If your loved one is in the early stages of Alzheimer’s disease, they’re probably used to taking their own medication. They may become unreliable and need help, but they may want to stay in charge of their pills. If so, it’s very important that they do it safely.

You can do several things to help with that:

Use a pill organizer box that you fill up once a week. Store the bottles of labeled medications somewhere safe. If they take medicines more than once a day, use a box that has sections labeled a.m. and p.m.
Make a routine to help them remember to take their medicine.
Try to fit the medication schedule to their daily routine.
Use a reminder like an alarm clock or a daily phone call to help them remember their medicine when you can’t be there.
If you don’t think they can safely handle their medicines on their own, try to work as a team. Talk with them about what reminders and assistance they would like.

It’s common for people in the early stages of Alzheimer’s to take medications for other conditions, but not take the ones for their Alzheimer’s. That’s because they focus on the condition they already have and don’t see a need to take more medicine for another.

In the later stages of dementia, you’ll need to take charge of your loved one’s medications. These steps can help that go smoothly:

Read labels. Know what all the medications are for and how your loved one should take them.
Be sure your loved one is only taking medicine they really need and that the dose is right. Have their doctor go over the list about every 6 to 12 months. They may be able to stop the ones they don’t need or change a dose. This means your loved one may be able to take fewer medications and may have fewer side effects.
Keep an up-to-date list of all medications in an easy-to-find place. Be sure it has the name of everything your loved one takes. This includes prescriptions, vitamins, herbals, and supplements. It should also have the dose for each one and how and when to take it.
Know the risks, benefits, and potential side effects of each one.
Make sure they take the right one at the right time.
Watch for side effects.
Know the risks of how each one might react to foods, supplements, and nonprescription medications.
Watch to see that your loved one doesn’t take their medicines without your knowledge.
Be sure to refill their prescriptions.
Ask the doctor or pharmacist to make the medication list simpler. They might be able to cut down on how many medicines your loved one has to take or the number of times a day they take it.
When you give them medicine, talk to them simply and clearly. Say something like, “Here’s the pill for your arthritis. Put it in your mouth.» Hand them a glass of water and say, «Have a drink of water to help the pill go down.”
If they won’t take their medication, don’t argue or fight. Instead, stop and try to find out why. Maybe their mouth hurts or the medication tastes bad. They may not remember how to swallow a pill or what it’s for. It may help to remind them that it’s the pill they asked for to ease pain, or that someone they trust thinks it will help. If they still won’t take it, try again later.
If they keep refusing, ask their doctor to see if there’s a physical cause. The doctor may also show you an easier way to give it, such as in a liquid or a tablet that dissolves.
To prevent an accidental overdose, keep all medications in a locked drawer or cabinet.
If you can’t be there when they take their medications, get someone else to help.

If your loved one misses a dose, don’t worry. Just take the next dose at the normal time and in the normal amount. Never give two doses at once. This more than doubles the risk of side effects. If your loved one misses medications often, talk about it with their doctor.

Questions to Ask the Doctor

If your loved one’s doctor prescribes a new medication, you could ask:

What is its name? Does it go by any other names?
Why have you prescribed this?
Do they have to take this medication? Are there any alternatives?
How often and at what time of day should they take it?
Should they take it with food or on an empty stomach?
Are there any side effects that I should watch for?
How much does it cost? Are there less costly or free alternatives?

Show Sources

Alzheimer’s Association: “Alzheimer’s & Dementia,” “Medications for Memory Loss.”

CDC, Agency for Toxic Substances and Disease Registry: “What are Cholinesterase Inhibitors?”

Alzheimer’s Society: “Memantine,” “Drug Treatments for Alzheimer’s Disease.”

Mayo Clinic: “Dementia,” “Vascular Dementia: Treatment and Drugs.”

Alzheimer’s Australia: “Drug Treatments for Alzheimer’s Disease: Cholinesterase Inhibitors.”

National Institute of Health, Medline Plus: “Understanding Alzheimer’s.”

University of North Carolina — Chapel Hill’s Sheps Center.

AARP Public Policy Institute: “Home Alone: Family Caregivers Providing Complex Chronic Care.”

American Society on Aging: “Four Medication Safety Tips for Older Adults.”

Social Care Institute for Excellence: “When People with Dementia Refuse Help.”

American Journal of Nursing: “Medication Management for People with Dementia.”

BMC Geriatrics: “Medication Management for People with Dementia in Primary Care: Description of Implementation in the DelpHi Study.”

Journal of Clinical Nursing: “Managing Medications: The Role of Informal Caregivers of Older Adults and People Living with Dementia. A Review of the Literature.”

Journal of Nursing and Healthcare of Chronic Illness: “The Process of Medication Management for Older Adults with Dementia.”

FDA: «FDA Grants Accelerated Approval for Alzheimer’s Drug.»

Biogen: «FDA grants accelerated approval for ADUHELM as the first and only Alzheimer’s disease treatment to address a defining pathology of the disease,» «Biogen and Eisai launch multiple initiatives to help patients with Alzheimer’s disease access ADUHELM.»

Centers for Medicare and Medicaid Services.

Butler Hospital: «Butler Hospital Administers World’s First Treatment of New Alzheimer’s Drug, Aduhelm.»

Falls and dementia

Dementia is a syndrome (a group of related symptoms) that is associated with an ongoing decline of the brain and its abilities. Some of these symptoms include memory loss and difficulties with thinking, problem solving, communication and language.

Risk of falling

Falls aren’t an inevitable part of living with dementia, however, some symptoms can make people with dementia more at risk of falls. People with dementia can also have the same health conditions that increase the risk of falls as people who don’t have dementia.

Risk factors with dementia

There are different personal risk factors that cause people to fall, however, people with dementia are at greater risk because they:

are more likely to experience problems with mobility, balance and muscle weakness
can have difficulties with their memory and finding their way around
can have difficulties processing what they see and reacting to situations
may take medicines that make them drowsy, dizzy or lower their blood pressure
are at greater risk of feeling depressed
may find it difficult to communicate their worries, needs or feelings

Each person will experience dementia in their own way, and may experience all or none of these risk factors.

Your mobility

If you have problems with mobility, balance and muscle strength, it’s important to remain physically active and get the right support to enable you to do this if you’re having difficulties. Physical activity may also help in avoiding, delaying or reducing some of the mobility problems associated with dementia.

Alzheimer Scotland has produced an Activities guide for carers of people with dementia (PDF, 608KB), with suggestions for keeping active.

Walking

Some people with dementia walk (sometimes referred to as “wandering”) that can put you at higher risk of fatigue, falls or getting lost.

Alzheimer Scotland has produced When people with dementia walk – guidance for Carers (PDF, 104KB), offering some useful advice.

Your medication

Antipsychotic, benzodiazepine and anti-depressant medications are sometimes used to treat the symptoms of dementia. These medications can put you at risk of falling as they’re known to cause:

drowsiness
dizziness
a drop in blood pressure when you stand up (postural hypotension)

If you think you’re experiencing any of these symptoms, speak to your GP as soon as possible.

Your vision

Dementia can affect the way we perceive and process information from our eyes. This can lead to sight loss, however, eye conditions that cause sight loss, and normal ageing of the eye, can also occur alongside dementia and could be the cause of this.

Loss of sight makes it more difficult to spot hazards and move around safely which puts you at risk of falls.

The RNIB have produced a Dementia and sight loss leaflet (PDF, 2MB) with a checklist for identifying sight loss.

Your environment

Environments that are dementia-friendly – meaning they’re easy to navigate and free from hazards – can also help prevent falls. To make an environment safe:

invest in bright bulbs and regular lighting
add signage to doors and walkways to help you find your way around
use contrasting colours to make things more visible. Chairs, beds or toilet seats that are a different colour to the floor are easier to see

Your thoughts and feelings

People with dementia are at higher risk of depression, which can make you less active, and affect how well you eat, drink and sleep, leading to an increased risk of falls. If you feel your mood is low, you should speak to your GP or other health or care professional.

Anything that makes you stressed, distressed or restless can also increase your risk of falls. Some common triggers include:

being in pain
being hungry or thirsty
needing to use the bathroom
being frightened, bored or lonely

It’s important for those who support you to try to understand what triggers these feelings.

Useful resources

Alzheimer Scotland have produced a Healthy living with dementia information sheet (PDF,120KB), offering advice on keeping active, eating well and staying socially and mentally active if you have dementia.

Telecare Self-Check online tool

Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer.

A List of Drugs Linked to Dementia Risk

While medications can have significant benefits, few are free of side effects. Some medications are shown to have negative effects tied to dementia. Plus, people often need more meds as they age, and their risk of dementia roughly doubles every five years after reaching 65.

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Drugs linked to increased dementia risk

At the moment, there’s no proof that certain drugs cause dementia. However, there are two drug classes that are clearly tied to higher dementia risk. The American Geriatrics Society and a number of studies strongly recommend doctors avoid prescribing these drugs to older adults when possible.

Since causation hasn’t been proven, there’s also no proof that certain drugs make dementia worse on their own. However, some common dementia symptoms, like confusion and memory loss, are known side effects of these types of drugs and others.

Anticholinergics

Anticholinergics are linked with significant increases in dementia risk. These include certain antidepressants, antiparkinsonians, antipsychotics, antiepileptic drugs, and bladder control medications. Adults 55 and older were nearly 50% more likely to develop dementia if they took just one anticholinergic on a daily basis for three years, according to a study published in JAMA Internal Medicine.

Read more from A Place for Mom on the connection between dementia and Benadryl .

Some anticholinergic drugs linked to dementia risk include:

Amitriptyline (Elavil)
Aripiprazole (Abilify)
Benztropine (Cogentin)
Biperiden (Akineton)
Brompheniramine (Dimaphen DM)
Carbamazepine (Tegretol)
Chlorpheniramine (ChlorTrimeton)
Chlorpromazine (Thorazine)
Clemastine (Dayhist Allergy)
Clomipramine (Anafranil)
Clozapine (Clozaril)
Cyproheptadine (Periactin)
Darifenacin (Enablex)
Desipramine (Norpramin)
Dexchlorpheniramine (Polmon)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Doxepin (Sinequan)
Doxylamine (Vicks NyQuil)
Flupenthixol (Depixol)
Fluphenazine (Modecate)
Haloperidol (Haldol)
Hydroxyzine (Vistaril)
Imipramine (Tofranil)
Loxapine (Adasuve)
Methscopolamine (Pamine)
Nortriptyline (Aventyl)
Olanzapine (Zyprexa)
Oxcarbazepine (Trileptal)
Oxybutynin (Ditropan)
Paliperidone (Invega)
Perphenazine (Trilafon)
Phenindamine (Nolahist)
Pimozide (Orap)
Propantheline (ProBanthine)
Pyrilamine (Codimal DM)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Solifenacin (Vesicare)
Thiothixene (Navane)
Tolterodine (Detrol)
Trifluoperazine (Stelazine)
Trihexyphenidyl (Artane)
Trospium (Sanctura)
Ziprasidone (Geodon)
Zuclopenthixol (Clopixol)

Benzodiazepines

Benzodiazepines are linked with a significant rise in dementia risk , according to a meta-analysis from the Journal of Clinical Neurology. Dementia risk was greater for people who took stronger benzodiazepines for longer periods.