Alzheimer's medication: what works, what to expect

Alzheimer's meds don't cure the disease, but they can ease symptoms, slow decline for months, and help with daily life. If you or a family member just got a diagnosis, knowing the options and realistic benefits makes decisions easier and less stressful.

Common medicines and how they work

There are two main groups of approved drugs most doctors use. Cholinesterase inhibitors — donepezil (Aricept), rivastigmine, and galantamine — raise levels of a brain chemical called acetylcholine. They’re prescribed for mild-to-moderate Alzheimer’s and can improve memory, thinking, and daily function for several months to a year in many people.

Memantine (Namenda) works differently; it targets glutamate activity and is usually used for moderate-to-severe Alzheimer's. Doctors sometimes combine memantine with a cholinesterase inhibitor when symptoms progress.

Recently, anti-amyloid monoclonal antibodies (examples include aducanumab and lecanemab) have appeared. They target amyloid plaques and may slow decline in early disease for some patients, but they require infusions, MRI monitoring, and carry risks like brain swelling (ARIA). These treatments are chosen carefully and often discussed with a specialist.

Side effects, safety, and simple monitoring

Side effects vary by drug. Common cholinesterase side effects are nausea, diarrhea, vivid dreams, and slow heart rate. Memantine can cause dizziness and confusion in some people. Anti-amyloid infusions can cause MRI-detectable brain swelling or small bleeds, so clinics monitor patients closely.

Practical safety tips: check pulse and blood pressure if your loved one starts a cholinesterase inhibitor; report fainting, severe stomach upset, or new confusion right away. Avoid strong anticholinergic drugs (some sleep or allergy meds) — they can cancel out cholinesterase benefits. Always tell the doctor about supplements and over-the-counter meds to prevent interactions.

Expectations matter. These drugs often give months of slower decline or modest improvement in daily tasks. They don’t reverse lost abilities. If a medication causes persistent side effects without clear benefit, discuss stopping it with the prescriber — quality of life matters more than continuing an ill-tolerated treatment.

For caregivers: track daily changes with a simple checklist (sleep, appetite, confusion, falls). That helps doctors judge if a drug is helping. Ask about local memory-care programs, support groups, and legal planning early — medication is only one part of care.

Want to read more? We have a deeper piece on memantine and updates about newer Alzheimer’s drug options. If you’re thinking about anti-amyloid therapy, bring recent MRI and a full medication list to your specialist visit so risks and benefits can be reviewed carefully.