Patient information from BMJ

Alzheimer's dementia: what are the treatment options?

Last published:Nov 16, 2023

Many of us start to forget things as we get older. But if someone has Alzheimer’s disease or another type of dementia, this forgetfulness gets very bad. The symptoms get worse over time.

There's no cure for Alzheimer's disease and most other kinds of dementia. But there are some ways to help cope. Some medicines may help a little with forgetfulness and confusion. Treatment should be based on someone's individual needs and their situation (for example, whether they live alone).

When someone is first diagnosed they should be referred to a social worker or mental-health professional so that they get the right support. They and their carers and family should also be told about community services that can help.

People with dementia will eventually need a lot of help looking after themselves. To read more about what happens in dementia and its symptoms, see the leaflet Alzheimer's disease and other types of dementia.

Treatments to help with memory and thinking

You might hear the problems with memory and thinking caused by dementia called 'cognitive impairment'. There are several types of medicine that can help with these problems. They fall into two main groups:

• cholinesterase inhibitors

• NMDA receptor antagonists.

Research has found that these medicines can help some people with dementia remember things better. They may help some people look after themselves for longer.

But these medicines don't help everyone, and you're unlikely to see a big improvement.

These medicines can have side effects. Some of the most common are feeling sick, getting diarrhoea, or not feeling like eating. If side effects become a problem, changing to a different treatment or a different dose might help, so talk to your doctor.

Non-drug treatments

Some people try a herbal remedy called Ginkgo biloba for dementia symptoms. But doctors don't usually recommend it because there is no reliable evidence that it helps.

It also isn’t often recommended because herbal products aren't tested in the same way as medicines. You can't always be sure how pure a product is.

Ginkgo biloba doesn't have many side effects. However, people who take Ginkgo should tell their doctor. That's because it can be harmful if taken with some medicines, especially drugs to prevent blood clots (such as aspirin or warfarin).

Getting the most out of life

To help people with dementia get the most out of life, therapists often encourage them to be as independent as possible and to do things they enjoy. If you’re close to someone with dementia you might want to try some of these ideas yourself.

Some therapists use things like word or number games, practising with money, or looking at pictures of famous faces. This is called cognitive stimulation. To help someone with dementia feel involved with life, they might be encouraged to talk about people in family photographs, play games, or do jigsaws. A large calendar or a blackboard can be used to remind people about what's happening that day. This kind of approach is called reality orientation.

Music therapy can also be used to try to help someone with dementia feel happier or more relaxed. It can involve listening to a recording, going to a concert, dancing, or playing instruments. Some research suggests that music can help people feel less restless and upset.

Occupational therapy aims to help people keep looking after themselves for longer. An occupational therapist can give advice on how to make day-to-day things easier. They can also suggest how to adapt someone's home to help them cope.

A treatment called reminiscence therapy aims to help people exercise their memory. People with dementia can often remember things that happened a long time ago better than things that happened recently. A therapist might ask someone questions about their childhood, or suggest they handle objects from their past. There’s not much research on this, but it might help.

Even simple things, such as playing with a pet, might help someone with dementia feel happier about life.

Treatments for people who are agitated or distressed

Some people with dementia become very distressed at times. They may get upset and anxious, or become convinced that unpleasant things are happening around them. Some people become angry or aggressive. If these things happen to your relative or loved one there are several techniques and treatments that their doctor may suggest.

Before considering medicines it may help to think whether any changes to someone's care could help them be less distressed. For example, someone might like more privacy, or want to be kept busy more of the time. A calming environment and techniques such as distraction may help. Any other illnesses or problems the person might be experiencing (for example, pain) should also be treated. 

Medical treatments for distress and restlessness can have dangerous side effects. Drowsiness is a common side effect and can be bad enough thatsomeone passes out. Make sure you talk to your doctor about side effects.

A different medicine or a change to how much medicine the person is taking might help to prevent side effects. If a doctor prescribes medicine for someone who's distressed, the treatment should be looked at regularly to see if it is still the right treatment. It should be stopped if it's no longer needed or doesn't help any more.

Some types of medicines called antipsychotic medicine can help people who get delusions (believe or think things that aren’t true). But they can cause serious side effects. Antipsychotic medicines increase the risk of a stroke and of early death when they're used to treat older people with dementia. In most cases doctors should not prescribe antipsychotic medicines for people with dementia.

Other medicines, such as antidepressants (medicines used to treat depression) and drugs used for epilepsy, are sometimes used to treat people with dementia who are upset and distressed. But this is unusual.

Where to get more help

If you have been told you have dementia, or if you are caring for someone with dementia, make sure you get all the help you can: for example, from your family, and social services. There are also local carers' groups that may be able to give you support. For example, in the UK, you can contact the Alzheimer's Society (alzheimers.org.uk ), Alzheimer Scotland (alzscot.org ), and Carers UK (carersuk.org ). Your doctor will also be able to suggest where you can go for help in your area.