Therapy tailored to dementia causes and symptoms
There is currently no cure for dementia, but a range of treatments can help. Medicines, non-medicine support and planning ahead are important parts of comprehensive dementia care.
Some medicines support memory and thinking, particularly in Alzheimer's disease. Others help manage mood, sleep or behaviour changes and require careful, individualised use.
In vascular dementia, treatment focuses on managing underlying blood vessel risk factors. Recently approved amyloid-targeting treatments may slow early Alzheimer's disease in selected patients.
What can medications do in dementia?
Dementia medications cannot cure dementia, but they may help with:
- day-to-day function
- memory and thinking
- mood, sleep or behaviour changes
- progressive damage to affected brain regions
- the underlying rate of progression in selected patients receiving newer treatments for early Alzheimer's disease.
The right medicine depends on your:
- stage of disease
- symptoms
- type of dementia
- other health conditions.
Your doctor will work with you to find the best options, and will reassess these regularly as your needs change.
These medicines are most often used in Alzheimer's disease and Lewy body dementia. They don't stop the disease, but some people find they help symptoms for a period of time.
- Donepezil, rivastigmine, galantamine (cholinesterase inhibitors) – may help with memory and thinking.
- Memantine – sometimes used for moderate to severe Alzheimer's disease.
These medicines usually offer modest benefits rather than reversing decline, and how well they work varies from person to person and an individual’s specific diagnosis.
Some people experience mild stomach upset when starting a cholinesterase inhibitor, which usually settles or can be managed by adjusting the dose. A doctor will consider whether these medicines are suitable.
Managing risk factors in vascular dementia
Vascular dementia happens when blood flow to the brain is reduced, often due to small strokes or narrowed blood vessels. Because of this, treatment usually focuses on protecting your blood vessels by managing:
- blood pressure
- blood-thinning medicine, if you've had a stroke or significant vessel disease
- cholesterol
- diabetes
- smoking, if relevant.
Managing risk factors will not reverse damage that's already happened, however, it can help prevent further damage and may slow the condition down.
Many individuals with dementia experience changes in mood or behaviour at some point. This can include:
- agitation
- anxiety
- low mood
- restlessness
- seeing or hearing things that aren't there (hallucinations)
- sleep disturbance.
These symptoms can be distressing for both the person and their family.
Before medicine is considered, doctors usually look for and address other possible causes, such as pain, infection, constipation, poor sleep or an unsettling environment.
Non-medicine approaches, such as routine, reassurance, activity and a calm environment, are usually tried first, as they can be just as effective and carry fewer risks.
When medicines are used, options may include:
- Antidepressants – may help with depression or anxiety. These are generally better tolerated than other options and are often considered first if mood symptoms need treatment.
- Medicines for agitation, distress or hallucinations – used when symptoms are severe or affecting safety. This group includes antipsychotic medicines, which require particularly careful consideration.
- Sleep-related medicines – used cautiously and generally only for a short time, as they can increase the risk of falls, confusion and daytime drowsiness in older people.
Why extra caution is needed
Some medicines used for agitation or hallucinations can cause serious side effects in older people, including:
- greater confusion or sedation
- increased risk of falls
- increased risk of stroke, with long-term use.
Lewy body dementia needs special care
Individuals with Lewy body dementia can have a severe sensitivity reaction to some antipsychotic medicines. This can cause a marked worsening of confusion, movement problems or sedation.
Because of this, these medicines are used only when necessary, at the lowest possible dose, and under close medical supervision.
In recent years, medicines have been developed to target amyloid, a protein that builds up in the brain in Alzheimer's disease. Two examples are:
- Donanemab
- Lecanemab
These treatments are administered by intravenous infusion (into a vein). They aim to remove amyloid from the brain and may help slow down the disease in its early stages. A specialist will consider whether these medicines are suitable.
While both medicines are currently approved for use in Australia by the Therapeutic Goods Administration, they are not subsidised on the national Pharmaceutical Benefits Scheme.
Who might be suitable for amyloid-targeting therapy?
These medicines are not for everyone with Alzheimer’s disease. They may be considered as an option by specialists for patients with:
- confirmed amyloid build-up, shown through testing
- early-stage Alzheimer's disease or mild memory problems caused by Alzheimer's
- patients who meet specific medical criteria.
What is involved before starting?
Before starting, you would usually need:
- an assessment of your memory and thinking
- a review by a specialist and detailed discussion about potential risks and benefits
- a brain scan
- a test to confirm amyloid deposition.
Ongoing brain scans and check-ups are needed while taking these medicines.
Common patient questions
No, there is currently no cure. However, medicines can help manage symptoms and some newer treatments may slow progression in early Alzheimer's disease for some people.
No, current medicines don't reverse dementia. They may help manage symptoms, or in early Alzheimer's disease, may affect how the disease progresses. Your specialist can explain what to expect from your specific treatment.
No, different types of dementia respond to different treatments. For example, memory medicines are used mainly in Alzheimer's disease, while vascular dementia is managed by treating risk factors like blood pressure and cholesterol.
Many dementia medicines can be started by your GP. Newer treatments that target amyloid usually require assessment by a specialist, along with brain scans.
Not at the time of writing (September 2026). Your doctor can give you the most current advice on cost and availability.
No, medication is usually just one part of your care. Lifestyle support, safety planning, and support for you and your family remain important too.