Treatments for different types of dementia

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options, please talk to a member of your health and social care team.

Although dementia is a lifelong illness that usually gets worse over time, there are treatments that can slow its development or help with some of the symptoms. There are two kinds of treatment.

  • Some treatments may help with symptoms that affect your thinking and memory (cognitive symptoms).

  • Other treatments may help with symptoms that affect your mood and how you behave (non-cognitive symptoms).

Some of the treatments are recommended for specific types of dementia and some are for all kinds of dementia.

If you have what is called mixed dementia (for example, Alzheimer's disease and vascular dementia, or Alzheimer's disease and dementia with Lewy bodies), you should usually be treated for the type that is thought to be the main cause of your dementia.

Treatments for cognitive symptoms

If you have mild or moderate dementia, you should be offered the chance to join other people with dementia in a cognitive stimulation programme.

Drugs for Alzheimer's disease

A NICE 'technology appraisal' has looked at when and how donepezil, galantamine and rivastigmine (drugs known as acetylcholinesterase inhibitors) and another drug called memantine should be used for Alzheimer's disease. This technology appraisal was published in March 2011 and updated in 2016.

NICE 'technology appraisal guidance' advises on when and how drugs and other treatments should be used in the NHS. More information about technology appraisals is available on the NICE website.


What has the NICE technology appraisal said?

Donepezil, galantamine, rivastigmine and memantine are recommended as possible treatments for some people with Alzheimer's disease.

You should be able to have donepezil, galantamine or rivastigmine if you have mild to moderate Alzheimer's disease. You should be able to have memantine if you have:

  • moderate Alzheimer's disease and cannot take donepezil, galantamine or rivastigmine or

  • severe Alzheimer's disease.

When assessing the severity of your Alzheimer's disease and the treatment needed, healthcare professionals should take into account any disabilities or difficulties in communicating that you might have.

Healthcare professionals should only prescribe these medicines on the advice of a clinician who has experience with Alzheimer's disease. This may be a doctor (such as a psychiatrist or your GP) or other healthcare professional (such as a nurse with special training).

You should only continue to take these medicines while you, your doctors and your family or carers agree they are having a worthwhile effect on your symptoms. You should have regular check-ups while taking any of these medicines.

What does this mean for me?

If you have Alzheimer's disease, and your doctor thinks that donepezil, galantamine, rivastigmine or memantine is the right treatment, you should be able to have the treatment on the NHS.

Donezepil, galantamine, rivastigmine and memantine should have been available on the NHS since 2011.

There are different tests and other methods that doctors can use to assess the severity of Alzheimer's disease, including tests designed to be used for people with a learning disability.

Drugs for other conditions

If you have mild problems with your thinking and memory, but have not been diagnosed with dementia, you should not be offered an acetylcholinesterase inhibitor to treat cognitive symptoms, except if you are taking part in a clinical trial.

If you have vascular dementia, you should not be offered an acetylcholinesterase inhibitor or a drug called memantine to treat cognitive symptoms, except if you are taking part in a clinical trial.

Treatments for non-cognitive symptoms

First, your care team should look at the situations that may affect your mood and the way you behave (for example, things that make you upset or agitated). They should look at things like your physical and mental health, whether you are in any pain and side effects of medicines you are taking. Your treatment and care should be planned to suit your needs (including taking account of your culture and beliefs), recorded in your notes, and reviewed regularly by your care team.

If you are agitated you should be offered therapies to help calm you. These may include:

  • aromatherapy, which uses plant extracts and oils to help relaxation

  • therapies that appeal to the senses, such as light displays and sounds

  • music and dance

  • contact with pets or other animals

  • massage.

Drugs for non-cognitive symptoms

You should be offered help and treatment without drugs before you are offered medication, unless you are severely distressed or are at risk of hurting yourself or someone else.

Antipsychotic drugs for non-cognitive symptoms

If your non-cognitive symptoms are mild or moderate, you should not be offered an antipsychotic because they can have serious side effects.

If you have severe symptoms (such as psychosis or you are very agitated), you may be offered an antipsychotic for a period of time, but only after your doctor has talked to you in detail about the possible benefits and risks, which can include having a stroke or a heart attack. If you start taking an antipsychotic, it should be at a low dose at first, and your doctor should monitor you very carefully.

Acetylcholinesterase inhibitors for non-cognitive symptoms

Type of dementia

Medication

Alzheimer's disease

You may be offered an acetylcholinesterase inhibitor if your non-cognitive symptoms are very distressing to you and other treatments have not worked or are not suitable.

Dementia with Lewy bodies

You may be offered an acetylcholinesterase inhibitor if your non-cognitive symptoms are very distressing to you.

Vascular dementia

You should not be offered an acetylcholinesterase inhibitor, except if you are taking part in a clinical trial.

Treatment for people whose behaviour is very disturbed

People with dementia can sometimes become violent, aggressive or very agitated. Some things, such as lack of privacy, lack of things to do, or poor communication, make this more likely. The care team should try to put these problems right. If people with dementia do become very disturbed, and there is a risk to themselves or to others, the staff caring for them should keep things as calm and as safe for them as possible.

If all efforts to reduce the risk of harm have not worked, staff may sometimes need to sedate the person with a drug called a benzodiazepine or an antipsychotic. The drug should usually be one that is taken by mouth and in a low dose.

If an injection is needed, it should usually be into a muscle, not into a vein, and the healthcare professional should check the person's blood pressure, pulse, temperature and breathing. He or she should also check for any side effects of the drugs (such as unconsciousness, tremor or restlessness). Very rarely, more than one type of drug may need to be injected if sedation is needed urgently.

If a person has been sedated, staff should explain why this was needed. Because it can be a very upsetting experience, people who have been sedated and their carers should be given the chance to discuss what happened with the care team. This should be written in the person's notes.

Healthcare professionals who use medications to help with agitated behaviour should have been trained in using them and understand their risks.

Treatments if you also have depression or anxiety

If you have depression or anxiety you may be offered a psychological treatment called cognitive behavioural therapy, which may involve your carer. You may also be offered other help, such as:

  • therapy that encourages people to remember events in their life (called reminiscence therapy).

  • therapies that appeal to the senses of touch, sight and hearing, such as hand massage, light displays and music

  • contact with pets or other animals

  • physical exercise.

If you have depression and the treatments above have not worked or are not suitable, you should be offered antidepressant medicine. Your doctor should explain the risks and benefits of the treatment. He or she should also explain that it is important to take the drug as prescribed, that it will not start working straight away and that you may have some withdrawal symptoms when you stop taking it.

Questions you could ask about any treatment or therapy

  • Please tell me why you have decided to offer me this particular type of treatment.

  • What are the pros and cons of having this treatment?

  • Please tell me what the treatment will involve.

  • How will the treatment help me? What effect will it have on my symptoms and everyday life? What sort of improvements might I expect?

  • What are my options for having other treatments instead?

  • Is there some written material (like a leaflet) about the treatment that I can have?

Questions you could ask about drug treatments

  • Are there any long-term effects or side effects of taking this medicine?

  • What should I do if I get any side effects? (For example, should I call my GP, or go to the emergency department at a hospital?)