Understanding the Common Medications for Alzheimer’s Disease

***This blog post is intended for informational purposes only. We do not recommend or endorse any specific medications, treatments, or interventions, nor do we make any claims regarding their effectiveness. Individuals and families are strongly encouraged to consult with their physician or qualified healthcare provider and to work closely with them when making decisions about care and treatment.***

Non-curable dementias, including Alzheimer’s disease, frontotemporal dementia, and Lewy Body dementia, are progressive neurological conditions for which there is currently no cure to stop or reverse disease progression. While various treatments and medications may be available to help manage symptoms or support quality of life, effectiveness can vary from person to person. A healthcare provider can help guide what options may be appropriate based on individual needs and circumstances.

 

Medications Approved for Dementia in Canada

Health Canada has approved several medications that target different biological processes involved in dementia.

 

Cholinesterase Inhibitors

Acetylcholinesterase inhibitors are commonly prescribed for Alzheimer’s disease. These medications work by preventing the breakdown of acetylcholine, a neurotransmitter that supports learning and memory.

In Alzheimer’s disease, the nerve cells that produce acetylcholine gradually deteriorate and die, leading to lower levels of this chemical in the brain. Cholinesterase inhibitors slow the breakdown of acetylcholine so that the remaining brain cells can communicate more effectively.

Examples of this classification of drugs include: Donepezil (Aricept), Galantamine (Reminyl), and Rivastigmine (Exelon).

These medications may be used in the early, middle, and sometimes later stages of Alzheimer’s disease. 

Some are also used in other dementias. For example, donepezil and rivastigmine may be prescribed for Lewy body dementia, and rivastigmine is also used in Parkinson’s disease dementia.

 

Memantine

Memantine (brand name Ebixa) works through a different biological pathway. It regulates the activity of glutamate, another chemical that helps brain cells send signals to each other.

In Alzheimer’s disease, damaged brain cells can release excessive glutamate. Too much glutamate overstimulates neighbouring cells and can contribute to further damage. Memantine blocks the harmful effects of excessive glutamate and helps protect the remaining brain cells from overstimulation.

 

Lecanemab (Newest)

Health Canada has recently approved a new treatment for Alzheimer’s disease called lecanemab (brand name Leqembi). According to the Canadian Consortium on Neurodegeneration in Aging (CCNA), this medication is designed to target and remove amyloid plaques in the brain and has been shown in clinical trials to modestly slow cognitive decline in people in the early stages of Alzheimer’s disease.

The CCNA further cited in their article that over the first 18 months, people taking them may experience about a 27% slower decline compared to those who do not. Because it works by targeting early disease processes, it is intended for people with mild cognitive impairment (MCI) or early-stage Alzheimer’s disease.

 

Potential Side Effects of Lecanemab

It is important to note, however, that these treatments can also cause serious side effects, primarily related to brain swelling or bleeding. In clinical trials:

• About 1 in 5 people needed extra brain scans or had to pause treatment.
• Around 1 in 30 experienced symptoms, with roughly 1 in 100 requiring hospitalization or experiencing lasting effects.
• In rare cases, these complications were life-threatening.

 

Cost and Coverage for Lecanemab in Canada

Additionally, the costs for treatment are expected to be significant and are estimated to be approximately $32,000 per year, not including additional expenses such as monitoring and imaging. 

On February 19, 2026, Canada’s drug agency recommended that lecanemab not be covered by provincial health insurance. The final decision is up to each province.

It is not yet clear if other provinces or private insurance plans in Canada will cover any of the cost.

 

Why Diagnosis and Monitoring Matter

Medication decisions for dementia depend on several factors. For treatment to be most effective, three things are particularly important: early diagnosis, identifying the type of dementia, and understanding the stage of the disease.

 

Early Diagnosis

Many dementia medications work by supporting the function of brain cells that are still alive, but they cannot restore neurons that have already died. 

Non- curable types of dementia, like Alzheimer’s Disease, cause progressive damage to brain cells and the connections between them, increasing the number of neurons lost and brain regions responsible for memory, reasoning, and behaviour gradually shrink.

Starting treatment early gives medications a better chance to preserve functioning brain cells. For example, cholinesterase inhibitors work on neurons that produce acetylcholine, which are more effective when enough of these cells remain.

Delaying diagnosis can reduce the benefits of treatment, as many neurons may already be lost.

 

Knowing the Type of Dementia

Different types of dementia involve different biological changes in the brain, which means medications do not work the same way for every condition.

For example, cholinesterase inhibitors may also benefit people with Lewy body dementia or Parkinson’s disease dementia, where similar neurotransmitter (acetylcholine) changes occur.

However, in vascular dementia, where symptoms are primarily caused by reduced blood flow and damage from strokes, the same medications may be less effective unless Alzheimer’s disease is also present. This is because the underlying mechanism of the disease is different.

 

Knowing the Stage of Dementia

Similarly, the stage of dementia also influences which medications may be helpful. Some treatments are designed for early disease processes, while others support brain function during later stages.

For example, lecanemab is intended for individuals with mild cognitive impairment (MCI) or early Alzheimer’s disease, when amyloid plaque removal may slow disease progression. 

In contrast, memantine is typically used in moderate to late stages, when excessive glutamate activity contributes to further damage of already vulnerable neurons.

 

Monitoring Treatment: The Importance of Knowing the Person’s Baseline

Before starting treatment, it is important to understand the person’s baseline: their usual behaviour, abilities, personality, and daily functioning. This baseline provides a reference point for evaluating whether a medication is helping.

Improvements may be subtle and may not always appear on cognitive tests. Instead, caregivers and healthcare professionals may notice changes such as the person being more engaged in conversation, more motivated to participate in activities, calmer, or better able to complete daily tasks.

In some cases, the benefit of medication may simply be stabilization. 

If dementia symptoms stop worsening for a period of time, this may indicate that the medication is slowing the progression of the condition.

When evaluating treatment effectiveness, small changes in daily life may be more meaningful than results from cognitive tests alone. For example, caregivers may notice that the person becomes more engaged in conversation, more interested in activities, calmer, or better able to complete daily tasks such as personal care.

Caregivers and healthcare professionals play an important role in noticing patterns or shifts in the person’s functioning, behaviour, or level of engagement. Consistent observation helps determine whether the medication is contributing to meaningful benefits in the person’s daily life or whether adjustments to treatment may be needed.

 

Living Well with Dementia

Although there is currently no cure for most forms of dementia, medications can still play an important role in care. When used appropriately, drug treatments may help reduce symptoms, slow disease progression, and support daily functioning.

Used alongside other supportive approaches, medications are just one part of helping people living with dementia maintain comfort, dignity, and daily functioning. Because there is still much to learn about these treatments, including their potential side effects and the significant costs that may limit access, it’s important to stay informed about all available care options.

By combining medications with non-drug approaches such as supportive environments, meaningful activities, and personalized care strategies, families and caregivers can help people living with symptoms of dementia stay engaged, maintain their abilities, and continue to enjoy everyday moments centered on quality of life, promoting comfort, purpose, and connection at every stage of the journey.

 

At Dementia Solutions, we’ve made it our mission to demystify dementia behaviour and continue to explore person-centred, creative, non-pharmacological solutions to manage dementia-related behaviours. We believe that awareness creation and skill-building through education is the most effective and powerful tool we have to promote and maintain the well-being of both the person with dementia and their caregiver.