Learning
Dementia medications
No medication cures dementia. Several slow decline modestly, two slow disease progression in early Alzheimer's, and many treat behavioral symptoms. Setting expectations matters.
Updated 2026-02-27
Cognitive medications (symptom management)
- Donepezil (Aricept) — cholinesterase inhibitor. Mild improvement in memory + attention. Common in mild-to-moderate stages.
- Rivastigmine (Exelon) — same class, available as a patch (easier if pills are refused).
- Galantamine (Razadyne) — same class.
- Memantine (Namenda) — different mechanism. Often added in moderate stage.
- Common side effects: nausea, diarrhea, leg cramps, vivid dreams.
Disease-modifying treatments (early Alzheimer's only)
- Lecanemab (Leqembi) — IV every 2 weeks. Slows decline ~27% over 18 months in mild-stage patients.
- Donanemab (Kisunla) — IV every 4 weeks. Slows decline ~35% in mild-stage.
- Both require: mild stage, biomarker confirmation (PET scan or CSF), no APOE4 homozygosity (or careful monitoring).
- Both have risk of ARIA (brain swelling or microbleeds) — requires monthly MRI monitoring first 6 months.
- Insurance: Medicare covers with strict criteria. Memory clinic referral needed.
Behavioral medications
- Brexpiprazole (Rexulti) — first FDA-approved for Alzheimer's agitation, 2023.
- Pimavanserin (Nuplazid) — for psychosis in Parkinson's dementia and Lewy body.
- Sertraline, citalopram — for depression + some anxiety.
- Trazodone — for sleep + agitation, fewer risks than benzos.
- Risperidone, quetiapine, olanzapine — older antipsychotics, used cautiously. Increased mortality risk in elderly.
Frequently asked questions
- When should we stop dementia medications?
- In late stage, most have minimal benefit. Talk to the doctor about deprescribing. Stopping often makes no noticeable difference.
- Is Leqembi worth it?
- Depends. Modest benefit, real risks, frequent infusions and scans. Discuss with a memory clinic specialist — not every primary care doctor is up to date.
Every dementia journey is different.
Memory Lane Care helps you understand what applies to your loved one, what to expect next, and which resources fit your family's situation.
Related across the journey
Memory Lane connects every part of dementia care. Here's how this topic threads into the rest.
Behavior Guidance
Hard Conversations
Keep reading
Learning
Alzheimer's vs dementia — what's the difference?
Dementia describes the symptoms. Alzheimer's is one specific disease that causes them — the most common one, but not the only one.
Learning
The stages of dementia
Dementia is progressive — symptoms worsen over time — but the path is never identical between people. Knowing the stages helps you plan, not predict.
Treatments
Brexpiprazole (Rexulti) for Alzheimer's agitation
Brexpiprazole became the first FDA-approved medication for Alzheimer's-related agitation in 2023. It's helpful for some — but it's a serious medication.
Behavior Guidance
Refusing medication
Skipping medications is dangerous, but forcing them is worse. Almost every med has an alternative — start with the pharmacist.
Learning
What is dementia?
Dementia is an umbrella term for a decline in memory, thinking, or behavior serious enough to interfere with daily life. It is not a normal part of aging.
Learning
Lewy body dementia
Lewy body dementia (LBD) is the third most common dementia. It shows up differently — visual hallucinations, sleep behaviors, Parkinson-like stiffness — and is dangerous to treat with the wrong medications.
GUIDE
Am I eligible for Medicare GUIDE?
GUIDE (Guiding an Improved Dementia Experience) is a Medicare program launched in 2024 that gives families a care navigator, 24/7 helpline, caregiver training, and up to $2,500/year in respite — all at no copay.
Learning
Mild cognitive impairment
MCI is the in-between space — symptoms beyond normal aging, but not yet dementia. About 1 in 3 MCI patients progress to dementia within 5 years. Early action matters.