How are Memory and Cognitive Problems Treated with Medications?

Acetylcholinerase Inhibitors

  • The primary class of medications used to treat thinking and memory problems are the acetylcholinesterase inhibitors, which are medications that increase levels of acetylcholine in the brain.

These medications include:

  • tacrine HCl, (Cognex®)
  • donepezil (Aricept®)rivastigmine (Exelon®)galantamine (Reminyl®)
  • RIVASTIGMINE is the only medication that was studied in patients with PD and was approved by FDA for use in PD dementia.
  • Other medications applied from the research studies in Alzheimer’s patients and their effectiveness in PD is not yet fully understood.
  • These medications are used to target the memory and attention problems seen in PD, and preliminary studies have shown positive results.
  • Some studies have also found that acetylcholinesterase inhibitors can improve psychotic symptoms. 
  • These medications are relatively safe and have few side effects for PD patients.
  • They do not typically produce marked improvements in cognition, but are thought to help slow the progression of cognitive deficits and help maintain the person’s current level of functioning.
  • It is important to bring cognitive changes to the attention of your health care provider, who can assess these issues and discuss treatment options.

A combination of medications and behavioral strategies is usually the best treatment for cognitive problems in PD.

Stimulant Medications

  • There are medications that are used to improve attention, increase general levels of arousal, and reduce daytime sleepiness.
  • Stimulant medications used to treat attention deficit disorder (ADD), such as methylphenidate (Ritalin®), or medicines used to treat sleep disorders such as modafinil (Provigil®), can be used to decrease fatigue, sleepiness and mental dullness.
  • Selegiline (Eldepryl®) is also used by some clinicians to combat daytime sleepiness and fatigue.
  • In general, the goal of these medications is to boost a patient’s energy level and stimulation. They do not, however, cure the biological cause of these cognitive problems.
  • People with PD who suffer from mental health comorbidities should not be given amoxapine.  If they are taking an MAO-B inhibitor for their PD, the current practice is to avoid concurrent tricyclic, SSRI, or SNRI antidepressants.  There is some controversy on this point, and some neurologists and neuropsychs are comfortable prescribing an MAO-B inhibitor concurrently with antidepressants if done under their close supervision.  For hallucinations and delusions, PD patients shouldn’t be on any neuroleptics except for quetiapine or clozapine.

Want to Learn More?

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Mind, Mood and Memory

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What medications help with cognitive impairment?

Medical content reviewed by: Nina Browner, MD—Medical Director of the NPF Center of Excellence at the University of North Carolina at Chapel Hill in North Carolina and by Fernando Pagan, MD—Medical Director of the NPF Center of Excellence at Georgetown University Hospital in Washington, D.C.

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