3.3 Medications for memory and thinking changes

Medications for dementia

In Australia there are four approved medications for symptomatic treatment of Alzheimer’s dementia. Medications with the generic (brand names in brackets) names donepezil (Aricept, Arazil), galantamine (Reminyl, Galantyl, Gamine-XR) and rivastigmine (Exelon, Rivastigmelon) are approved for people with mild-to-moderate Alzheimer’s disease. Memantine (Ebixa, Memanxa), is approved for people with moderate to severe Alzheimer’s dementia. A specialist like a psychiatrist, geriatrician or neurologist might be needed to prescribe these.

These medications work by increasing or balancing levels of a certain chemical (acetylcholine) that is responsible for transmission of memory between brain cells. These medications are thought to maintain memory and thinking for about a year, in some people with Alzheimer’s dementia, vascular dementia and Lewy body dementia. Like all medications, there are side effects and these might include vivid dreams or gastrointestinal symptoms such as loose bowels.

Souvenaid

Souvenaid ® is not a medication but a drink that contains many nutrients and vitamins thought to support cognition in mild Alzheimer’s disease or mild cognitive impairment. It has been recommended to take one bottle a day. Like the medications described above, Souvenaid ® will not prevent the progression of dementia.

You can read more about these medications including side effects at the Australian Commission on Safety and Quality in Health Care.  If you are interested, make an appointment with your GP or specialist to discuss if these medications are suitable for you.

Vascular Dementia

There are no specific medications for vascular dementia, however your doctor may prescribe medication to reduce your risk of further vascular damage in the brain. These might include medications to lower blood pressure, reduce cholesterol or reduce the risk of clots in the blood stream. If your doctor thinks you may have mixed dementia (e.g. Alzheimer’s and vascular dementia) they may prescribe one of the Alzheimer’s medications described above as well.

Pain can make memory and thinking difficulties worse

Pain makes us all miserable, but it can impair thinking too. If you have pain, from any cause, talk with your doctor and keep your pain well managed.

Disease-modifying therapies

Unfortunately, there is no cure for dementia. However, some people with early/mild Alzheimer’s dementia may be able to access disease-modifying therapies, drugs called donanemab and lecanemab. These medications have been shown to reduce the amount of abnormal amyloid build up in the brain.

These treatments are not available on the Pharmaceuticals Benefit Scheme (PBS) and are very expensive. These treatments need to be administered in specialised treatment centres, often in metropolitan located hospitals, and are given intravenously (injection) four-weekly or fortnightly. Brain scans (MRIs) need to be done regularly to monitor for potential treatment related brain swelling (oedema) or bleeds.

It remains unclear whether the reduction in amyloid results in any meaningful improvement in day-to-day life for people living with dementia. If you are interested, we recommend you speak to your general practitioner or specialist about these treatments.

Some medications could make memory or thinking worse

Some commonly prescribe medications for other conditions such as incontinence, kidney disorders, sleep disorders, depression, asthma, allergies, heart conditions and more could make your memory thinking worse by blocking the brain chemical acetylcholine that is responsible for transmission of memory between brain cells. If you are concerned, do not stop taking your prescribed medications, but talk to your GP about the number and types of medications you are taking. This includes those medications prescribed by your doctors and those you buy over-the-counter at pharmacies or health food shops.

For more information, read our article about anticholinergic medications. If you are concerned you can talk to your doctor about getting a medication review.