Treatment - Alzheimer's disease

There's currently no cure for Alzheimer's disease. But there is medicine available that can temporarily reduce the symptoms.

Support is also available to help someone with the condition, and their family, cope with everyday life.

Medicines

A number of medicines may be prescribed for Alzheimer's disease to help temporarily improve some symptoms.

The main medicines are:

Acetylcholinesterase (AChE) inhibitors

These medicines increase levels of acetylcholine, a substance in the brain that helps nerve cells communicate with each other.

They can currently only be prescribed by specialists, such as psychiatrists or neurologists.

They may be prescribed by a GP on the advice of a specialist, or by GPs that have particular expertise in their use.

Donepezil, galantamine and rivastigmine can be prescribed for people with early- to mid-stage Alzheimer's disease.

Rivastigmine can also be applied as a patch.

The latest guidelines recommend that these medicines should be continued in the later, severe, stages of the disease.

There's no difference in how well each of the 3 different AChE inhibitors work, although some people respond better to certain types or have fewer side effects, which can include nausea, vomiting and loss of appetite.

The side effects usually get better after 2 weeks of taking the medicine.

Memantine

This medicine is not an AChE inhibitor. It works by blocking the effects of an excessive amount of a chemical in the brain called glutamate.

Memantine is used for moderate or severe Alzheimer's disease. It's suitable for those who cannot take or are unable to tolerate AChE inhibitors.

It's also suitable for people with severe Alzheimer’s disease who are already taking an AChE inhibitor. Side effects can include headaches, dizziness and constipation but these are usually only temporary.

For more information about the possible side effects of your specific medicine, read the patient information leaflet that comes with it or speak to your doctor.

Medicines to treat challenging behaviour

In the later stages of dementia, a significant number of people will develop what's known as behavioural and psychological symptoms of dementia (BPSD).

The symptoms of BPSD can include:

• increased agitation
• anxiety
• wandering
• aggression
• delusions and hallucinations

These changes in behaviour can be very distressing for both the person with Alzheimer's disease and their carer.

If coping strategies do not work, a consultant psychiatrist can prescribe risperidone or haloperidol, antipsychotic medicines, for those showing persistent aggression or extreme distress.

These are the only medicines licensed for people with moderate to severe Alzheimer's disease where there's a risk of harm to themselves or others.

Risperidone should be used at the lowest dose and for the shortest time possible as it has serious side effects. Haloperidol should only be used if other treatments have not helped.

Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.

Sometimes other medicines may be recommended to treat specific symptoms in BPSD, but these will be prescribed "off-label" (not specifically licensed for BPSD).

It's acceptable for a doctor to do this, but they must provide a reason for using these medicines in these circumstances.

Treatments that involve therapies and activities

Medicines for Alzheimer's disease symptoms are only one part of the care for the person with dementia.

Other treatments, activities and support – for the carer, too – are just as important in helping people live well with dementia.

Cognitive stimulation therapy

Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve memory and problem-solving skills.

Cognitive rehabilitation

This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks.

Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not.

Reminiscence and life story work

Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.

Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.

These approaches are sometimes combined. Evidence shows they can improve mood and wellbeing.

Read more about how dementia is treated.

Find out how to live well with dementia and more useful information in the NHS Dementia Guide.