Pharmacological treatment options

Pharmacological treatments

Unfortunately, there is no cure for dementia, so the main goals of treatment are to maintain quality of life, maximise function in daily activities, enhance recognition, mood and behaviour, foster a safe environment, and promote social engagement.

Consideration of both pharmacological and non-pharmacological interventions is recommended.


Pharmacological therapies for the cognitive symptoms associated with Alzheimer's disease

There are different medications and treatment regimes for dementia. The main types of medication that can be used are:

  • Cholinesterase Inhibitors
  • Memantine
  • Risperidone

These approved medications help assist the symptoms of Alzheimer's disease (in turn, improving the quality of life for people living with the disease and their families and carers) but they do not treat the underlying disease or delay its progression 

It is important to communicate to patients and their families what the expected modest benefits of these medications are, and the fact that decline will continue despite the medication provided.

Medication Management and Medication Review

After starting a medication, patients should be regularly reassessed. This should include standardised tests of cognition and function to determine the medication's effectiveness and possible side-effects (and drug interactions relating to the use of multiple medications. Carers or family members should ideally also be consulted.

Regular reviews of the patient's general practice dementia management/care plan is recommended and ensure that your patient and their family/carers are empowered with information about their medications in order that they can make informed decisions concerning their own health.

For more information please visit the government health website


Cholinesterase inhibitors

Cholinisterase Inhibitors are the most commonly prescribed medications for dementia. There are 3 cholinisterase inhibitors, which include, Donepezil, Galantamine and Rivastigmine. 

Generic name: Donepezil - tablets 5mg & 10mg
Brand name(s): Aricept and others

Generic name: Galantamine - prolonged capsules 8mg, 16mg, 24mg
Brand name(s): Galantyl and others

Generic name: Rivastigmine - transdermal patches 4.6mg/24 hours and 9.6mg /24 hours
Brand name(s): Exelon, Exelon Patch

Important to note:

  • There are no significant differences in effectiveness between the three drugs. 
  • Choice depends on availability, cost and side-effects.
  • Adverse effects may be minimised by increasing the dose gradually and ensuring the patients take their medication with a meal. Side effects usually resolve over time or, if necessary, with dose reduction.
  • Patients who do not respond to one acetylcolinersterase inhibitor may respond to another.
  • Monitor patients who have a history of peptic ulcer or who are taking NSAIDS. Monitor patients for bradycardia who are taking B-blockers or other rate slowing medications.

PBS-indications:

  • Cholinisterase Inhibitors are PBS-listed for patients with mild-to-moderate Alzheimer's Disease.
  • It should be noted that, in Australia, a specialist medical practitioner (neurologist, psycho-geriatrician, geriatrician or psychiatrist) must confirm the diagnosis of Alzheimer's disease in order for a patient to be eligible for subsidised Alzheimer's disease medications.
  • Cholinisterase Inhibitors are not listed on the PBS when used in later stages of AD or other types of dementia (e.g. Lewy body disease, vascular dementia). However, there are clinical trials that suggest the drug's effectiveness on this cohort.
  • For criteria and updates concerning the Pharmaceutical Benefits Scheme (PBS) subsidisation of medication for Alzheimer's disease, please visit: the PBS website OR the NPS MedicineWise 

For more information:


Memantine

Memantine is another drug used in assistance for moderately severe Alzheimer's Disease.

Generic name: Memantine
Brand name(s): Ebixa, APO-Memantine, Memanxa

It is important to note:

  • Memantine is usually well-tolerated, although the dose may need to be reduced in patients with renal impairment

PBS-indications are:

  • Memantine is listed for patients with moderately severe Alzheimer's Disease.
  • It should be noted that, in Australia, a specialist medical practitioner (neurologist, psycho-geriatrician, geriatrician or psychiatrist) must confirm the diagnosis of Alzheimer's disease for a patient to be eligible for subsidised Alzheimer's disease medications.
  • There is some evidence the drug may be effective for people with mild to moderate Alzheimer's disease and for people with vascular dementia. However, in Australia it is not yet PBS-approved for these conditions.
  • For criteria and updates. please visit the PBS website  and/or NPS MedicineWise

For more information:


Risperidone and Behavioural and Psychological Symptoms of Dementia (BPSD)

The only drug listed by the PBS for treating BPSD is risperidone

Generic name: Risperidone
Brand name(s): Risperdal, APO Risperidone, Ozidal, Rispa, Risperdal, Rispericor, Rixadone, Rispemia

Important to note:

  • Risperidone is an atypical antipsychotic drug belonging to the benzisoxazole-derivative class. It is a selective monoaminergic antagonist with high affinity for serotoninergic 5-hydroxytryptamine2, dopaminergic D2 and alpha1-adrenergic receptors.
  • Depending on state laws, psychotropic interventions may require informed consent or proxy consent, verbally or in writing
  • This medication has the strongest evidence for its effectiveness for the treatment of aggression and psychosis. Like all other agents used to treat BPSD, it may not be effective, or may cause significant side effects

PBS-indications:

  • The updated indications for risperidone include treatment (up to 12 weeks) of psychotic symptoms, or persistent agitation or aggression unresponsive to non-pharmacological approaches in patients with moderate to severe dementia of the Alzheimer type.

For more information:

Online video series for general practice:

NPS MedicineWise 

The use of restraints and psychotropic medications in people with dementia. Alzheimer's Australia numbered publications, paper 38, March 2014.

Dementia Behaviour Management Advisory  Service (DBMAS) 

Drugs used to relieve behavioural and psychological symptoms of dementia Alzheimer's Australia Q&A help sheet 04

Dementia and Risperidone Alzheimer's Australia Q&A help sheet 05

DBMAS Behaviour Management: A Guide to Good Practice. Managing Behavioural and Psychological Symptoms of Dementia 

Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD): A Handbook for NSW Health Clinicians' 

BPSD Quick Reference Cards 

Changed Behaviours & Dementia Alzheimer's Australia help sheet section

Depression and dementia Alzheimer's Australia Q&A help sheet 15

Antipsychotics and dementia: Managing medications (online video) 

Reducing Behaviours of Concern. A Hands on Guide. A resource to assist those caring for people living with Dementia  

Medication and Dementia Report


Pain Management

People with dementia may be less able to communicate to their carers and health care providers that they are in pain, resulting in reduced quality of life and increased BPSD. This can be avoided by looking out for non-verbal signs of pain and providing adequate treatment.

For more information:

Pain and dementia

Abbey Pain Scale


Future treatment breakthroughs:

Researchers are looking for new ways to treat Alzheimer's disease and other forms of dementia.

To keep abreast of research initiatives, please visit the Alzheimer's Australia Dementia Research Foundation.


Participation in clinical trials:

Some patients may be interested in participating in clinical trials or other research studies.

Read more about current research occurring in Australia


NPS Medicines and Dementia

A resource for people with dementia and their carers (AA and NPS Medicinewise publication) and accompanying tips sheets – www.nps.org.au/dementia