3.6 Medications to manage changes

Medications for dementia

In Australia there are four approved medications for symptomatic treatment of 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 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.

Medications for psychiatric symptoms and behaviour changes

People with dementia can often become depressed and anxious for many reasons, including having dementia, thoughts of ‘being a burden’ and needing support. They might also lose touch with reality and may hear people talking when there is no one around (auditory hallucinations or voices) or get worried that people are trying to harm them or are stealing things and become suspicious (paranoia). These fears might manifest as agitation, restlessness, irritability and even shouting. It is recommended that a general practitioner and /or specialist such as a psychiatrist, geriatrician or neurologist assess these symptoms.

People with dementia might need medications to help with these symptoms, such as an antidepressant (e.g. sertraline, escitalopram) or anxiolytic (i.e. an anti-anxiety drug) or an antipsychotic (e.g. risperidone). It is recommended that non-pharmacological (i.e. non-drug) strategies are tried first before these medications.

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

Pain can be a cause of changes

Many people, especially in older age, experience pain. This includes people with dementia, who may not be able to tell you they are in pain, or where it might be located. People with dementia may react to pain by being restless and irritable or even shouting. It is worth considering that pain might be a cause of someone’s distress and an assessment by a general practitioner as a start is recommended.

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. These are medications that have been shown to reduce the amount of abnormal amyloid build up in the brain. In 2025, two medications, donanemab and lecanemab, were approved for use by the Australian Therapeutic Goods Administration (TGA), in May and September, respectively. 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. These have been reported to occur earlier in the treatment with brain scans recommended 3 -4 times in the first 6 months. The early clinical trial using donanemab involved mostly older people with Alzheimer’s dementia, aged between 60 – 85 years old, with the average age of 73 years old (TRAILBLAZER trial) with mild cognitive impairment.

It remains unclear whether the reduction in amyloid results in meaningful improvement in day-to-day life for people living with dementia. It also remains unclear what the effects of these treatments are on younger people with Alzheimer’s dementia and those with significant mental health symptoms and other medical conditions. We recommend you speak to your general practitioner or specialist about these treatments.

It’s important to note that people with other types of dementia, such as frontotemporal or vascular dementia, may have fewer approved treatment options, and these medications may be less effective. In some cases, antipsychotics or other medications may be used to manage specific symptoms such as agitation, aggression, or severe mood changes, but these are prescribed cautiously due to side effects, some of which can be serious.

Photo: Christine Sandu via Unsplash.