Medications that worsen dementia: what families should know

Key insights

• No current medicine stops, slows down or reverses dementia, although four medicines can temporarily help with memory and thinking in some types
• Some medicines can worsen confusion, drowsiness and falls in dementia, including certain anticholinergic drugs, antipsychotics and sleeping tablets
• NICE (National Institute for Health Care and Excellence) recommends antipsychotics only when a person is at risk of harm or severely distressed, and Lewy body dementia carries particular risk
• Never stop a medicine alone. Ask the GP or pharmacist for a medication review first

Many people living with dementia also take medicines for other health conditions, and some of those medicines can add to confusion, drowsiness or unsteadiness. The medications that worsen dementia symptoms are usually prescribed for good reasons, such as bladder problems, low mood or poor sleep. That’s why families can miss them.

This guide explains which types of medicine deserve a second look, what the evidence says, and what to do if you’re worried. It draws on guidance from NICE and the Alzheimer’s Society, and it’s general information, not medical advice. Never stop or change a medicine without speaking to the prescriber or a pharmacist first, because stopping suddenly can cause harm too.Hometouch’s dementia care at home takes the person’s full medication list into account, and our clinical team reviews each custom care plan as health needs change.

Which medications worsen dementia, and why?

Four groups of medicine deserve particular care: anticholinergic drugs, antipsychotics, sleeping tablets and some steroids. Between them, these medicines can affect memory and thinking, alertness, mood and balance, and those effects can be harder to spot and more serious in someone already living with dementia.

It helps to separate two ideas. A medicine can worsen dementia symptoms, for example by confusing, without causing dementia. Some medicines have also been linked to a higher long-term risk of dementia, which is a different question. This guide covers both, and says which is which.It also helps to know what medicine can and can’t do. No current medicine stops, slows down or reverses dementia. Four medicines (donepezil, rivastigmine, galantamine and memantine) can temporarily help with memory and thinking for some people, and the Alzheimer’s Society describes the overall benefit as modest. They are used for Alzheimer’s disease, dementia with Lewy bodies, Parkinson’s disease dementia and mixed dementia. No medicine currently improves the symptoms of vascular dementia.Medicines are only one part of care. Routine, activity and the right environment matter just as much, and Hometouch helps families plan dementia care alongside other health conditions with this in mind.

Why are anticholinergic drugs a concern in dementia?

Anticholinergic drugs block acetylcholine, a chemical messenger that helps brain cells communicate, and that can affect memory and thinking. They are used for conditions including depression, bladder problems, Parkinson’s disease, hay fever and travel sickness. Guidelines for doctors say these drugs should be avoided for frail older people because of their effect on memory and thinking, according to a 2018 statement from the Alzheimer’s Society.

The same source describes a large study of more than 300,000 people over 65, funded by the Alzheimer’s Society and published in the BMJ in 2018. It linked some anticholinergic drugs to a higher risk of dementia. These were treatments for depression, bladder problems and Parkinson’s disease. The researchers found no evidence of a higher risk with medicines for hay fever, travel sickness or stomach cramps. The study’s authors said the link could reflect an effect of those drug classes, or drugs being used for very early symptoms of dementia.

Frequently prescribed examples include the antidepressants amitriptyline, dosulepin and paroxetine, the bladder medicines tolterodine, oxybutynin and solifenacin, and the Parkinson’s treatment procyclidine. Not all antidepressants are anticholinergic, and in most cases alternatives exist, according to the Alzheimer’s Society.

This doesn’t mean everyone who takes one will develop dementia, and it doesn’t mean the medicine should be stopped without advice. The Alzheimer’s Society advice is to speak to the doctor and be guided by them before stopping any treatment. A GP or pharmacist can check whether an alternative suits the person during a medication review.

What about sleeping tablets and benzodiazepines?

Sleep medication isn’t recommended for a person with dementia, according to the Alzheimer’s Society. Drugs aren’t very effective at improving sleep in dementia, and most sleeping tablets have unpleasant or potentially dangerous side effects, such as dizziness and a higher risk of falls. Some doctors may suggest a short course when sleep problems are severe and non-drug approaches have not worked.

The Alzheimer’s Society says that if the person does take sleep medication, they may be more confused and more likely to fall the next day, so extra care is needed. It says clonazepam, a benzodiazepine sometimes used for REM sleep behaviour disorder (which is common in Lewy body dementia), may worsen other symptoms of dementia, cause daytime drowsiness and raise the risk of falls or sleep apnoea.

Research on benzodiazepines and dementia risk is mixed. One large study of older people in Quebec, published in the BMJ, found that people who took them for more than six months were more likely to be diagnosed with Alzheimer’s disease later. The authors said the drugs might be treating early symptoms rather than causing it. A 2022 review of 35 studies found the link didn’t hold once studies at risk of that bias were excluded, while a 2018 review found that it did. Guidelines advise short-term use only.

Sleep problems also have other causes. Pain, constipation, a urinary infection, anxiety and the medicines for dementia itself, such as donepezil, rivastigmine or galantamine, can all disturb sleep. The Alzheimer’s Society says taking those medicines in the morning rather than at bedtime may help, which is a question for the prescriber. A diary of when sleep problems happen helps a clinician see what is going on. Restlessness and confusion in the evening (sundowning) are common too, and a steady routine can help.

What other medicines can cause confusion?

Steroids such as prednisolone can affect mood. The NHS says some people notice mood changes and mental health problems while taking it, and that higher doses can cause more intense changes. Anyone who notices a change in mood should talk to their doctor or contact NHS 111. Anyone who has taken prednisolone for more than a few weeks should also check with their doctor before stopping it suddenly.

Some medicines for movement problems can cause trouble too. In dementia with Lewy bodies, levodopa can increase confusion or make hallucinations worse, according to the Alzheimer’s Society. Its sleep guidance adds that medicines for restless legs syndrome, such as pramipexole, ropinirole and rotigotine, may worsen hallucinations or delusions in people who already have them.A sudden change in confusion doesn’t always point to a medicine. Infection, dehydration, pain and constipation can all increase confusion, as the Alzheimer’s Society notes for dementia with Lewy bodies, so ask the GP to check for these as well.

Are antipsychotics safe for people with dementia?

Antipsychotics carry serious risks in dementia, so NICE recommends them only when a person is at risk of harming themselves or others, or is severely distressed. NICE’s decision aid recommends they are tried alongside other ways of easing distress, used at the lowest dose that helps for the shortest possible time, and reviewed at least every six weeks. They should be stopped if they aren’t helping or are no longer needed.

The risks are specific. NICE’s figures show that, for every 1,000 people with dementia who take an antipsychotic for 6 to 12 weeks, on average 12 have a stroke because of the medicine and 11 die because of it. The Alzheimer’s Society also lists drowsiness, confusion, unsteadiness, falls, chest and urinary infections, and worse memory and thinking among the possible effects.Non-drug approaches come first. NICE gives music, exercise and aromatherapy as examples, and the Alzheimer’s Society advises checking for causes such as infection, pain or constipation before any medicine is considered. Antipsychotics don’t help with every behaviour, either. They don’t help with distress during personal care, repetitive vocalisations, walking about or social withdrawal. The first prescription should come from a specialist, usually an old-age psychiatrist, a geriatrician or a GP with a special interest in dementia.

Why does Lewy body dementia need particular care?

People with Lewy body dementia are at particular risk. The Alzheimer’s Society says up to half of people with dementia with Lewy bodies who take antipsychotics have severe reactions, including stiffness, difficulty moving, more confusion and difficulty communicating. These drugs also significantly increase the risk of stroke and sudden death.

If an antipsychotic can’t be avoided, it should be prescribed by a specialist, in very small doses, with close monitoring, and withdrawn as soon as possible. When the person goes into hospital or sees a new doctor, check that the team knows the diagnosis is Lewy body dementia, not just “dementia”, and that it’s recorded in their notes. This matters most for families caring for someone with Lewy body dementia at home.

What should families do if a medicine is a concern?

A calm, step-by-step approach works best.

1. Don’t stop or change anything alone. Stopping some medicines suddenly can cause harm
2. Ask the GP surgery for a medication review. A medication review is a meeting with a pharmacist, doctor or nurse to go through your medicines, as Age UK explains. Bring a full list, including anything bought without a prescription. Dementia UK’s Admiral Nurses can also help families work through medication reviews and care decisions
3. Write down what you notice. Note when confusion, drowsiness, unsteadiness or falls happen, and when medicines are taken. A clear record helps a clinician see patterns
4. Ask the questions the Alzheimer’s Society suggests. Why is the medicine prescribed, and for which behaviours? Have medical causes been ruled out? Are there non-drug approaches that haven’t been tried? What’s the plan to come off it, and when will it be reviewed?
5. Make sure every clinician knows the exact diagnosis. This matters most for Lewy body dementia, because it changes which medicines are safe
6. Act quickly if someone suddenly becomes much more confused, drowsy or unwell after a new medicine. Contact the GP or NHS 111 the same day, and call 999 in an emergency

How does medication safety work with live-in care at Hometouch?

Every Hometouch arrangement is built around a custom care plan designed with the full clinical picture in mind, including diagnoses, medication schedules and potential interactions. Care plans are reviewed and adapted as health needs change. Carers are supported to follow clear guidance and to escalate concerns to our nursing-led clinical team, which stays in contact with the healthcare professionals involved in the person’s care. That way, changes to medicines are followed correctly and new concerns are picked up promptly.

Because one carer lives with the person, they can notice small changes in drowsiness, balance or confusion early and raise them. All of Hometouch’s live-in care arrangement is overseen by a doctor-founded clinical team, and that includes coordinating dementia care alongside other health conditions with the healthcare professionals involved.

Frequently Asked Questions

Do any medicines cure or slow dementia?

No. No current medicine stops, slows down or reverses dementia, according to the Alzheimer’s Society. Four medicines (donepezil, rivastigmine, galantamine and memantine) can temporarily help with memory and thinking in some types of dementia, and the benefit is modest. The GP or memory service can say whether they suit the person.

Which medicines should people with dementia avoid?

No medicine is banned for everyone with dementia, but some need particular care, including anticholinergic drugs, antipsychotics and sleeping tablets. A pharmacist, doctor or nurse can check each medicine against the person’s needs in a medication review. Ask for one before anything is changed.

Can I stop a medicine if I think it is making dementia worse?

No, speak to the GP or pharmacist first. Stopping some medicines suddenly can cause harm, including a sudden worsening of symptoms, as the Alzheimer’s Society explains for dementia medicines. Note what you have seen and ask for a medication review.

Are antipsychotics dangerous for someone with dementia?

Antipsychotics carry serious risks, including a higher risk of stroke and death, so NICE recommends them only in specific situations. In Lewy body dementia, up to half of the people who take them have severe reactions, according to the Alzheimer’s Society. Any prescription should come from a specialist, with regular review.

Do anticholinergic drugs cause dementia?

Some anticholinergic drugs are linked to a higher risk of dementia, particularly with long-term use. That doesn’t mean everyone who takes one will develop dementia, so talk to a doctor before changing anything.

Here when you need us

Medications that worsen dementia are rarely a sign that anyone has done something wrong. Most are prescribed for sound reasons, and the right response is usually a review, not a sudden stop. The pattern to remember is short: some medicines need particular care in dementia, antipsychotics carry the highest stakes, and Lewy body dementia raises them further. Ask for a medication review, write down what you notice, and make sure every clinician knows the exact diagnosis.

Families don’t have to work through this alone. Our clinical team reviews each custom care plan with the person’s full medication list in mind, and carers are supported to raise concerns early.Talk to one of our care experts about how medicines are managed in live-in care.