Since the late 20th century, drugs have been at the forefront of treatment strategies for mild cognitive impairment and dementia. There are two categories of medications that are prescribed for this condition: medications that help to resolve symptoms of the disease, and medications that can actually slow or change the progression of the disease.

Treating Symptoms

In the first category, the medications help with symptoms related to memory and cognition. There are two classes of this type of medication that are currently used: cholinesterase inhibitors and glutamate regulators. These drugs work by altering the chemical messengers involved in memory and judgement. Cholinesterase inhibitors are the most commonly prescribed medications to improve memory and cognitive function in people with Alzheimer’s. The most common are: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). Another common type of medication is memantine. It is a good option for people who cannot tolerate cholinesterase inhibitors or both types of medications can be used in combination.

These drugs can offer symptomatic relief, helping with memory, thinking, language, and other cognitive abilities. Also, they do not have to be taken in the earliest stages of the disease to be effective and can still have a beneficial effect on cognitive symptoms in moderate to severe stages of the condition. However, they do not halt the progression of the condition.

Additionally, these medications can have side effects that it is important to look out for. Common side effects are nausea, vomiting, or other gastrointestinal symptoms, as well as headache and dizziness. It is important to tell a doctor about any side effects that occur.

Slow the Progression

The other category contains two medications that have been proven to slow the progression of Alzheimer’s disease. Alzheimer’s disease is a common cause of dementia, in which amyloid-beta protein accumulates abnormally in the brain. The amyloid-beta protein forms plaques that disrupt cell function and trigger neurodegeneration. These medications help to break down amyloid-beta plaques in the brain, which slows down the progression of dementia. It is most effective when taken in the early stages of the disease. The two medications in this category are Lecanemab and Aducanemab. These are new medications and they are the only two amyloid-targeting drugs that have been approved by the FDA so far for the treatment of dementia.

These medications also have side effects. These include headache, dizziness, higher likelihood of falls, and, like many medications, they can cause allergic reactions in some people. Another side effect that can be severe is called ARIA, which is temporary swelling or bleeding in the brain. The symptoms of ARIA are headache, dizziness, nausea, confusion and vision changes. If these symptoms occur, it is important to urgently consult a doctor. There is a genetic risk factor called ApoE ε4 that can increase the risk of ARIA. Before starting an amyloid-targeting medication, the patient should be screened for this genetic risk factor with a blood test.

It is important to talk to a doctor about which medications are right for you or your loved one. These medications can interact with other medications someone might already be taking, or the type of disease may not be affected by these drug types. Also, some people may have other risk factors such as the ApoE ε4 gene that makes them ineligible for certain treatments. The following is a list of questions we recommend asking your doctor before starting pharmaceutical treatment.

Questions for your doctor:

• What treatment options are available to me?
• Am I eligible for one of the medications that slows disease progression (i.e. Lecanemab, Aducanumab)?
• Will my treatment be covered by insurance? If not, what are my options?
• What effect should I expect from taking this drug?
• Which symptoms does the treatment target?
• How long will it take to see the result of the treatment?
• What side effects should I look out for? How likely are they to occur?
• If I do experience side effects, will I need to stop taking the drug?
• What side effects or events are considered an emergency? At what point should I call you?
• Does this treatment interfere with any of the other medications I am taking?
• When should I stop using this treatment?

Treating Alternative Causes of Dementia

It is very common for dementia to occur alongside other conditions. A study in the UK found that people with dementia typically have 4 to 5 chronic conditions in addition to dementia. Common chronic conditions include depression, diabetes, hearing loss, cardiovascular diseases (which includes hypertension), and musculoskeletal disorders. These conditions can even cause dementia or dementia-like symptoms. For example, conditions that affect blood circulation and the vascular system, such as diabetes and cardiovascular disease, can cause vascular dementia.

Memory loss and other problems with thinking can be caused by other undiagnosed (but curable) conditions or vitamin deficiency. Commonly, these are depression or another psychiatric disorder, medication side effects, alcohol or cannabis use, thyroid disease, or vitamin deficiency. People with dementia or people who suspect they have dementia should work closely with their medical provider to manage other known conditions and to check for other treatable conditions that could be causing the symptoms.

Clinical Trials and Experimental Treatments

New medications are constantly being developed to treat dementia. Donanemab is another promising drug that works similarly to Lecanemab and targets amyloid-beta proteins in Alzheimer’s disease. Some drugs target another protein that causes plaques in Alzheimer’s disease called tau proteins, while others target inflammation in the brain that can contribute to dementia. Other drugs use prevention strategies. Neuroprotective drugs protect neurons from damage caused by dementia, and there are even vaccines being developed for dementia.

Drug approval is a rigorous process to ensure that new pharmaceuticals are effective and safe for humans to take. It often takes years for a drug to get approved by the FDA and become available for doctors to prescribe. In the meantime, the drug will go through many clinical trials. It is possible to join clinical trials to gain access to new experimental drugs. If you are interested in this, you can use the Alzheimer’s Association’s user-friendly tool to find clinical trials that are relevant to your situation. This tool is called TrialMatch. Alternatively you can search for clinical trials at ClinicalTrials.gov.