Medication for Alzheimer’s Disease

For Alzheimer’s disease that hasn’t advanced—meaning that a person’s abilities to learn, pay attention, solve problems, and remember are only slightly impaired—NYU Langone doctors may prescribe a medication belonging to a class of drugs called cholinesterase inhibitors. These medications may include donepezil, or Aricept^®; rivastigmine, or Exelon^®; or galantamine, or Razadyne^®. They regulate acetylcholine—a chemical in the neurons, or nerve cells, in the brain that helps to transmit messages throughout the body.

With more acetylcholine available, the neurons may temporarily communicate more effectively. Donepezil and rivastigmine can also be used for people with more advanced symptoms of Alzheimer’s disease.

For people with moderate to severe Alzheimer’s disease, NYU Langone doctors may prescribe a medication called memantine, or Namenda^®. A brain chemical called glutamate is important for memory and learning, but in large amounts glutamate can kill brain cells, leading to problems with memory and learning. People with Alzheimer’s may have higher-than-normal levels of glutamate in the brain. Memantine works to slow down the damage in the brain that excessive glutamate can cause.

This medication may help slow the progression of memory loss, confusion, or thinking problems. Sometimes, doctors prescribe memantine in combination with a cholinesterase inhibitor.

Depression may also accompany Alzheimer’s disease, and it can be quite difficult to identify, as a person with the disease becomes increasingly withdrawn and struggles to express the hopelessness, anger, and sadness that can be associated with depression.

NYU Langone doctors may recommend antidepressants called selective serotonin reuptake inhibitors (SSRIs). These medications work by blocking the reabsorption of a chemical messenger, or neurotransmitter, in the brain called serotonin. Serotonin relays signals between the brain’s nerve cells to regulate mood, appetite, and sleep.

Raising the amount of serotonin available in the brain helps neurons to better pass along messages from one nerve cell to another. This leads to improved mood and lessened anxiety. SSRIs prescribed for Alzheimer’s disease include sertraline, or Zoloft^®; paroxetine, or Paxil^®; and citalopram, or Celexa^®.

For people with Alzheimer’s disease who experience psychosis or agitation, antipsychotic medications, such as risperidone, or Risperdal^®; olanzapine, or Zyprexa^®; and quetiapine, or Seroquel^®, may be considered. These medications can help reduce symptoms such as hallucination, agitation, paranoia, mania, hostility, and aggression. Doctors use these medications with caution in older people with dementia, because they can increase the risk of dying from a cardiovascular cause such as stroke or an infection such as pneumonia.

NYU Langone doctors recommend regular appointments for people with Alzheimer’s disease to ensure that medications are working and to manage any side effects.