Which medications are used in the treatment of delirium, dementia, and amnesia?

Updated: Sep 19, 2018
  • Author: Richard D Shin, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

Outpatient medications for primary dementia are coordinated best by health care providers who have continuing contact with the patient. Medications may include the following:

  • Anticholinesterase inhibitors, such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon): These medications are useful early in the disease course, but they lose their effectiveness or may worsen mental status in advanced stages of the disease.

  • N -methyl D -aspartate (NMDA) receptor antagonists, including memantine (Namenda)

  • Antidepressants, especially the selective serotonin reuptake inhibitors or bupropion. Avoid tricyclic antidepressants because of their anticholinergic properties which can worsen dementia.

  • Benzodiazepines for sedation or sleep. However, these drugs may worsen cognitive deficits, increase the risk of falls and are best avoided if possible.

  • Antipsychotics for psychotic ideation or aggressive behavior: High-potency agents are preferred. Risperidone (Risperdal), a newer atypical antipsychotic, is well tolerated and useful for sundowning. However, the atypical antipsychotics as a group have been associated with a slightly higher death rate in patients with dementia (3.5% vs. 2.3% for placebo). Despite a US Food and Drug Administration (FDA) black box warning, experts warn against abandoning this class of medications in the treatment of dementia-related psychosis and aggression.


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