Currently, pharmacological treatment options for people with Alzheimer’s disease address the symptoms. They do not modify the disease. They fall into two categories:

• Acetylcholinesterase (AChE) inhibitors – NICE recommends an AChE inhibitor (such as donepezil, rivastigmine or galantamine) as monotherapy for managing mild-to-moderate Alzheimer’s disease.
• • Between 40 and 70% 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.
    
    
• 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 licensed 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 taking medicines to treat the underlying conditions such as stroke, high blood pressure, high cholesterol, diabetes or heart problems.

Pharmacy professionals should (if appropriate) provide advice about adopting a healthy lifestyle. For example, taking regular exercise, stopping smoking if relevant (signposting them to smoking cessation services), eating a healthy diet, and if they drink alcohol, sticking within the chief medical officer's low risk drinking guidelines.  

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.

Donepezil or rivastigmine may be prescribed by specialists for people with mild-to-moderate dementia with Lewy bodies, although this use is unlicensed. 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.