🎵 "Comfortably Numb" – EOA Understanding the Medications Used in Early Onset Alzheimer's (Pink Floyd)
One of the first things I noticed after Rob's diagnosis wasn't just the appointments...
It was the prescriptions.
One pill became two.
Two became four.
Then someone suggested another medication.
Pretty soon, I found myself asking...
"Wait...what is this all for?"
If you're feeling overwhelmed looking at your spouse's medication list...
You're not alone.
Let's walk through some of the most common medications you'll hear about in Early Onset Alzheimer's and Dementia.
KEEP IN MIND YOU AND YOUR SPOUSE SHOULD TALK ON DAY 1 OF DX, do you want to stay where you are today, or move at a rapid escalation this disease is brutal and terminal with an average of 5-7 years? Some of these drugs all slow down visable signs of decline, they do not cure or fix, they give you more time at a slower pace of decline. There is no wrong decision.
💬 First Things First
(2026) There is currently no medication that cures Alzheimer's disease. I will do a seperate post on the injections.
The medications doctors prescribe generally fall into two categories:
🧠 Medications that may temporarily help memory or thinking
❤️ Medications that help manage symptoms like anxiety, depression, hallucinations, agitation, sleep problems, or behavioral changes.
Sometimes finding the right combination takes patience, adjustments, and close communication with your neurologist.
🧠 Memory & Thinking Medications
💊 Aricept (Donepezil)
What it's for:
Mild to severe Alzheimer's disease
May help memory, attention, and daily functioning for some people
How it works:
Helps increase acetylcholine, a chemical messenger important for memory.
Common Sid
e Effects
Nausea
Diarrhea
Loss of appetite
Weight loss
Muscle cramps
Fatigue
Slow heart rate (bradycardia)
Dizziness
Fainting
Increased urination
⚠️ One side effect many caregivers report—ourselves included—is extremely vivid dreams or nightmares.
For Rob, this became a real issue.
The dreams were so realistic that he would act them out in his sleep, sometimes punching, kicking, or talking loudly without realizing it. Eventually, it became unsafe for us to sleep in the same bed, and separate bedrooms gave both of us better sleep.
Some neurologists recommend taking Aricept in the morning instead of bedtime if vivid dreams become problematic. Never change dosing without talking with your physician.
Less Common but Important
Very vivid dreams or nightmares
Sleepwalking
Acting out dreams (REM Sleep Behavior Disorder)
Agitation
Hallucinations (rare)
⚠️ Call your doctor if you notice:
Fainting
Black stools
Severe vomiting
Very slow heartbeat
Repeated falls
💊 Namenda (Memantine)
Sometimes called Memantine.
Often added during moderate stages.
What it's for
Moderate to severe Alzheimer's
May help:
Attention
Thinking
Daily functioning
Sometimes prescribed together with Aricept.
Common Side Effects
Dizziness
Headache
Constipation
Sleepiness
Confusion
High blood pressure
Less Common
Hallucinations
Restlessness
Balance problems
⚠️ Call your doctor if confusion suddenly worsens.
❤️ Depression & Anxiety
💊 Escitalopram (Lexapro)
One of the most commonly prescribed medications for anxiety and depression.
Many people with Early Onset Alzheimer's experience anxiety before diagnosis.
In some families, anxiety is actually one of the earliest symptoms of the disease.
May help with:
Anxiety
Depression
Irritability
Common Side Effects
Upset stomach
Diarrhea
Headache
Fatigue
Dry mouth
Sweating
Trouble sleeping
Decreased libido
Less Common
Increased anxiety during the first couple of weeks
Tremors
Low sodium (especially in older adults)
⚠️ Seek emergency care for:
Thoughts of self-harm
Severe confusion
High fever with muscle stiffness (possible serotonin syndrome)
💜 Our experience: Rob originally took a generic version that upset his stomach. After switching formulations, he tolerated it much better..
💊 Alprazolam (Xanax)
Usually prescribed only for short-term anxiety.
May help:
Panic attacks
Severe situational anxiety (it does help with Travel or long road trips)
⚠️ Can also increase:
Confusion
Falls
Sleepiness
Memory problems
Common Side Effects
Sleepiness
Confusion
Poor balance
Memory problems
Slowed thinking
Risks
Falls
Dependence
Withdrawal
Increased confusion in dementia
Most neurologists try to avoid long-term benzodiazepines in dementia unless absolutely necessary.
🌙 Sleep
💊 Trazodone
Very commonly prescribed in dementia.
May help:
Sleep
Nighttime anxiety
Sundowning symptoms
Common Side Effects
Morning grogginess
Dry mouth
Dizziness
Low blood pressure
Sleepiness
Less Common
Confusion
Falls
⚠️ Be cautious getting out of bed overnight because dizziness may increase fall risk
😡 Agitation & Aggression
Sometimes behavioral symptoms become severe enough that medications are considered after trying non-drug approaches.
These decisions should always involve the treating physician and careful discussion of benefits and risks.
💊 Seroquel (Quetiapine)
An atypical antipsychotic sometimes prescribed off-label for severe agitation, hallucinations, or psychosis in dementia.
It may help:
Hallucinations
Delusions
Aggression
Severe agitation
Common Side Effects
Sleepiness
Weight gain
Increased appetite
Dizziness
Dry mouth
Constipation
Serious Risks
Increased stroke risk
Increased mortality in dementia patients
Falls
Low blood pressure
⚠️ FDA Boxed Warning
Seroquel and other antipsychotics carry an FDA boxed warning for an increased risk of death in older adults with dementia-related psychosis. These medications are generally reserved for situations where symptoms are severe, dangerous, or causing significant distress after weighing the potential benefits and risks.
💊 Depakote (Divalproex Sodium)
Originally developed as a seizure medication and mood stabilizer.
Sometimes used off-label for:
Agitation
Mood instability
Common Side Effects
Tremors
Weight gain
Sleepiness
Nausea
Hair thinning
Weakness
Dopped head
Serious Risks
Liver problems
Pancreatitis
Low platelets
Routine blood work is often recommended.
💊 Keppra (Levetiracetam)
Primarily an anti-seizure medication.
Usually prescribed only if seizures develop.
It is not considered a routine Alzheimer's medication.
Some people experience mood changes or irritability while taking it.
Common Side Effects
Sleepiness
Dizziness
Weakness
Poor coordination
Behavioral Side Effects
One of the most common reasons people stop Keppra is because it can cause:
Irritability
Anger
Mood swings
Aggression
Anxiety
Depression
Many neurologists specifically ask caregivers to monitor personality changes after starting Keppra
🩺 Other Medications You May Hear About
💊Brexpiprazole (Rexulti)
The first FDA-approved medication specifically for agitation associated with Alzheimer's dementia.
Common Side Effects
Headache
Dizziness
Sleepiness
Weight gain
Restlessness
Like other antipsychotics, it also carries an FDA boxed warning for increased mortality in older adults with dementia-related psychosis.
💡 Medication Isn't Everything
One thing I've learned is that medications are only one piece of the puzzle.
Sometimes what helps just as much is:
✔ A consistent daily routine
✔ Better sleep
✔ Exercise
✔ Music
✔ Occupational therapy
✔ Speech therapy
✔ Reducing overstimulation
✔ Caregiver education
✔ Knowing what stage you're actually in
❤️ Questions I Always Ask the Doctor
When starting a new medication, I ask:
Why are we prescribing this?
What symptom are we trying to improve?
How long before we know if it's working?
What side effects should I watch for?
When should I call the office?
What happens if it doesn't help?
Could this interact with other medications?
Is there a safer alternative?
I write the answers down.
Because caregiver brain is real too.
🎵 Why "Comfortably Numb"
Because sometimes it feels like every appointment ends with another prescription.
And while medications can absolutely improve quality of life for many people, they're only one part of caring for someone with Alzheimer's.
The goal isn't to medicate away the person you love or drag this disease on to make you all suffer longer.
The goal is to reduce suffering, preserve dignity, and help them have the best quality of life possible for as long as possible.
📋 Helpful Resources
💬 Disclaimer:
Keep in mind, I am writing this blog over years, not in one day- I repeat some things, but because it became more applicable today. I’m not a doctor, lawyer, therapist, or expert—just a wife trying to figure this out one day at a time. Everything shared here is based on our experience and things that have helped us along the way. Take what helps, leave what doesn’t, and always check with professionals when needed. I also use AI to help clean up my writing, organize thoughts, and pull together resources because honestly… caregiver brains are tired too. If something here helps another family feel less alone, then it’s worth sharing.
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