Cholinesterase Inhibitors for Dementia — What Families Need to Know

Three medications — donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) — are the first-line pharmacological treatments for mild-to-moderate Alzheimer’s disease in Canada. They belong to a drug class called cholinesterase inhibitors.

What they do: These medications work by slowing the breakdown of acetylcholine, a neurotransmitter involved in memory and cognitive function. They do not reverse or cure dementia. They can slow the rate of decline and, in some people, produce modest improvements in cognition and daily function.

What to realistically expect: The research shows that cholinesterase inhibitors produce meaningful benefit in roughly 50% of people who take them. About 30% show modest improvement. About 20% show no response. There is no reliable way to predict who will respond before trying the medication.

Side effects to watch for: The most common are gastrointestinal — nausea, vomiting, diarrhea, and reduced appetite. These are most pronounced when starting or increasing the dose and often diminish after two to four weeks. Taking the medication with food and at bedtime (for donepezil) reduces GI side effects. Vivid dreams are a common complaint with nighttime dosing.

Questions to ask your doctor:

• Which specific medication are you recommending and why?
• What dose will we start with and what’s the target dose?
• How long before we know if it’s working?
• What signs would indicate it’s not working or causing harm?
• How does this interact with other medications my parent takes?
• At what point would you recommend stopping it?

Important note: This article provides general information only. Medication decisions for dementia care should always be made in consultation with your parent’s physician or specialist. If you want a qualified second opinion on a medication recommendation, giniehealth.com connects Canadian families with specialist geriatricians within days.