Currently, pharmacological treatment options for people with Alzheimer’s disease are addressing the symptoms rather than modifying the disease. They fall into two categories:

1. Acetylcholinesterase (AChE) inhibitors: NICE recommends an AChE inhibitor, such as donepezil, rivastigmine or galantamine, for managing mild-to-moderate Alzheimer’s disease. Between 40 and 70 per cent of people with Alzheimer’s disease benefit from AChE inhibitor treatment, but it is not effective for everyone and may improve symptoms only temporarily; between six and 12 months in most cases. People who take an AChE inhibitor may find it helps with anxiety, motivation, memory, concentration and ability to continue daily activities.
2. N-methyl D-aspartate (NMDA) receptor antagonists: NICE guidance recommends memantine monotherapy as an option for managing moderate Alzheimer’s disease where people who are intolerant of or have a contraindication to AChE inhibitors, or severe Alzheimer’s disease. For people with an established diagnosis of Alzheimer’s disease who are already taking an AChE inhibitor, memantine can be prescribed in addition to this in moderate-to-severe disease.

There are currently no drug treatments specifically for vascular dementia (VaD). The medicines used in Alzheimer’s disease are not recommended for VaD. If the cardiovascular disease that caused the VaD has been controlled, it may be possible to slow down the progression of dementia. In most cases, a person with VaD will be on medicine to treat the underlying conditions such as stroke, high blood pressure, high cholesterol, diabetes or heart problems. Pharmacy professionals should advise a person with VaD to adopt a healthy lifestyle, in particular exercising regularly, and if they are a smoker signpost them to smoking cessation services, as well as healthy eating and the recommended levels of alcohol consumption.

Managing the symptoms of dementia with Lewy bodies (DLB) starts with focusing on which symptoms are most problematic for the person. Where possible, advice should be offered on how to manage symptoms before recommending medicine. Staying mentally active and using practical strategies to live well with memory loss can be used to support people with DLB. NICE recommends donepezil or rivastigmine to people with mild-to-moderate dementia with Lewy bodies. Galantamine is only considered for people with mild-to-moderate dementia with Lewy bodies if donepezil and rivastigmine are not tolerated. Memantine is considered if AChE inhibitors are not tolerated or are contraindicated. Donepezil, rivastigmine, galantamine and memantine do not have a UK marketing authorisation for this indication.

Mixed dementia should be managed according to the dominant condition. For example a person diagnosed with mixed Alzheimer’s and VaD would benefit from the management of their risk factors, such as smoking and hypertension, and may also be on an AChE inhibitor such as donepezil.