Dementia medication review (Review of medicines for dementia and its symptoms)

What is a dementia medication review?

A dementia medication review is an appointment to take a careful look at all the medicines a person with dementia is taking — both the medicines aimed at memory and thinking, and any used for symptoms such as agitation, sleep or low mood. The aim is to check that each medicine is still helping, is at the right dose, and is not causing more harm than good.

The main dementia medicines are the cholinesterase inhibitors (donepezil, rivastigmine and galantamine), used for mild-to-moderate Alzheimer's disease and some other dementias, and memantine, used for moderate-to-severe Alzheimer's or when the others are not suitable. It is important to be honest about what they can do: these medicines can help some people with symptoms for a time, but their benefits are usually modest, they do not work for everyone, and they do not cure dementia or stop it getting worse.

The review also looks at medicines used for distress and behaviour. Antipsychotic medicines are sometimes prescribed, but they carry an increased risk of stroke and death in people with dementia, so they should be used only when someone is severely distressed or at risk of harm, at the lowest dose, for the shortest time, and reviewed often. People with Lewy body or Parkinson's disease dementia can be especially sensitive to antipsychotics and may react badly to them.

A good review is as much about safely stopping or reducing medicines that are no longer helping as it is about starting new ones.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Common dementia medicines at a glance

Benefits of the memory medicines are usually modest. Antipsychotics carry serious risks and are a last resort, used briefly and reviewed often.

Preparing for your appointment

• Bring every medicine the person takes, including tablets, patches, drops, inhalers, over-the-counter remedies and supplements.
• Bring a list of any side effects or new symptoms, and when they started.
• Note any changes in memory, alertness, mood, appetite, sleep or behaviour since the last review.
• Bring someone who knows the person well, as their observations are central to judging benefit.
• Think in advance about what matters most to the person now — for example comfort, alertness or fewer tablets.
• Bring previous clinic letters and any recent blood-pressure or heart-rate readings if you have them.
• Write down questions, including whether any medicine could now be reduced or stopped.

What happens

The clinician — often a GP, memory-clinic doctor, nurse or pharmacist — goes through each medicine in turn. They ask what difference it seems to be making, what side effects there are, and how the person is doing overall. They will usually check the heart rate before and during treatment with cholinesterase inhibitors, because these can slow the pulse, and they look for medicines that might be adding to confusion.

For memory medicines, they weigh up the modest expected benefit against any side effects and the person's stage of dementia. For medicines used for distress or behaviour, they ask whether non-drug approaches have been tried and whether the medicine — especially an antipsychotic — is still needed.

The clinician then agrees a plan: continue, change the dose, switch, add, or carefully reduce or stop a medicine. Any reduction is usually done gradually, with a clear plan to review the effect. They will also discuss the person's wishes and, where the person cannot decide for themselves, work in their best interests with family.

Is this appointment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The two biggest issues are over-treating and under-reviewing. Memory medicines should be continued only while they are genuinely helping, and antipsychotics carry a real risk of stroke and death and should be used only when truly needed and reviewed often. Ask what benefit is expected, how it will be judged, when the medicine will next be reviewed, and whether any drug could now be safely reduced. If Lewy body dementia is possible, ask specifically about antipsychotic sensitivity.

Published figures to discuss

The benefits of dementia medicines are modest and vary between people, and there is no reliable way to predict who will respond. The clearest evidence on risk concerns antipsychotics, which are associated with an increased chance of stroke and death, as well as falls, chest infections and other harms, in people with dementia — with risk rising the higher the dose and the longer they are used. Exact figures depend heavily on the population studied and the specific drug, so they are best discussed individually rather than presented as a single number.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from a review. "Afterwards" is about following the agreed plan and watching, over the next weeks, whether any change has helped or caused problems.

• Mild stomach upset, poor appetite or loose stools in the first couple of weeks of a cholinesterase inhibitor, often settling.
• Taking time to tell whether a medicine is making a worthwhile difference.
• Some return of symptoms when a medicine that was not clearly helping is reduced.
• Needing more than one review to get the balance right.

Aftercare

• Follow the agreed plan and do not stop or change doses suddenly on your own.
• Watch for and write down any side effects, and report troubling ones promptly.
• Keep an up-to-date medicines list and bring it to every appointment.
• Use non-drug approaches for distress — routine, reassurance, comfort, activity — alongside or instead of medicines.
• Keep follow-up appointments so benefit and risks can be re-checked.
• Know who to contact about side effects or if the person becomes more distressed.
• Ask for a medication review again if things change, rather than waiting for the next routine one.

• All medicines, supplements and patches brought to the appointment
• A written list of side effects and changes since last time
• Someone who knows the person well present
• Recent heart-rate or blood-pressure readings, if available
• Questions about reducing or stopping medicines
• A copy of the agreed plan and the date of the next review

⚠ Get urgent help if…

• Fainting, a very slow pulse, chest pain or collapse — call 999; cholinesterase inhibitors can slow the heart.
• Severe or persistent vomiting, or being unable to keep fluids down.
• New or worsening severe drowsiness, stiffness or high fever after an antipsychotic — seek urgent medical help.
• Sudden confusion, weakness, facial drooping or slurred speech — call 999, as these can be signs of a stroke.
• Frequent falls, especially after a medicine has been started or increased.
• Marked worsening of distress, agitation or low mood — contact the clinician. For urgent mental-health support, call 111 and choose the mental-health option where it is offered (in England, Scotland and Wales); in Northern Ireland call Lifeline free on 0808 808 8000, or contact GP out-of-hours or the local crisis service. The Samaritans are available at any time on 116 123.
• Any new thoughts of self-harm in the person or an exhausted carer — seek help; call 999 if there is immediate danger.
• If you are unsure how urgent a problem is: for anything life-threatening call 999 or go to A&E; for urgent but non-life-threatening advice use NHS 111 in England, Scotland or Wales, or in Northern Ireland contact the GP out-of-hours service or your local HSC Trust's Phone First service.

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your psychiatrist gives you.

Results & realistic expectations

A good outcome from a review is not necessarily more medicine — it is the right medicine, at the right dose, for as long as it helps, with side effects kept low. For some people this means continuing a memory medicine that is helping; for others it means reducing or stopping one that is not, or safely coming off an antipsychotic.

A review cannot make dementia better or stop it progressing, and it cannot guarantee that a medicine will help. What it can do is make treatment safer and better matched to the person, and make sure decisions reflect what matters most to them and their family.

Medicines for dementia need regular review because dementia changes over time and so does the balance of benefit and risk. A medicine that helped at one stage may stop helping, or its side effects may matter more as a person becomes frailer. Plans are therefore not fixed; they are revisited, and many medicines are reduced or stopped as the illness advances and priorities shift towards comfort.

Related tests, treatments or support

A dementia medication review usually goes hand in hand with reviewing the person's wider health, mood, sleep, hearing and eyesight, and with non-drug support such as cognitive stimulation therapy, routine and carer support. It links closely with assessment of distress and behaviour, and with planning for the future.

Follow-up & long-term care

Follow-up is arranged to judge the effect of any change, usually after a few weeks for a new or stopped medicine, and then at regular intervals. Cholinesterase inhibitors and antipsychotics in particular need ongoing review. A named contact should be available for side effects or worsening symptoms between appointments.

• Regular, planned reviews of every dementia and behaviour medicine for benefit, dose and side effects.
• Heart-rate checks for people on cholinesterase inhibitors.
• Time-limited use of antipsychotics, with active attempts to reduce or stop them.
• Keeping a single, up-to-date medicines list shared with everyone involved.
• Reassessing the plan whenever the dementia stage or general health changes.

Repeat, follow-on and what comes next

• Doses are often adjusted, and medicines switched, to balance benefit against side effects.
• Memory medicines are commonly reduced or stopped as dementia advances or benefit fades.
• Antipsychotics should be actively reviewed with the aim of reducing or stopping them where possible.
• More than one review is usually needed to get the balance right.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A clear, written plan stating what to continue, change, reduce or stop, and why.
• Defined timing for judging the effect of any change and for the next review.
• Heart-rate monitoring for cholinesterase inhibitors and active review of any antipsychotic.
• A named contact for side effects or worsening symptoms between appointments.
• Decisions that reflect the person's wishes and stage of illness, with carer support in place.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The length of the appointment and whether it is a brief check or a full medicines review.
• Who carries it out — a GP, specialist doctor, nurse or pharmacist.
• Whether blood tests or a heart tracing (ECG) are needed before some medicines.
• The cost of the medicines themselves and any monitoring.
• Whether a written plan and GP letter are included.
• Whether follow-up reviews are part of the arrangement.

• The length of the appointment and who carries it out.
• Whether any blood tests or heart tracing are included or charged separately.
• Whether the cost of medicines and monitoring is covered.
• Whether a written medication plan and GP letter are provided.
• What follow-up reviews are included and how often.
• Who to contact about side effects between appointments.
• What happens, and what it costs, if medicines need changing or further tests are required.

On the NHS? Dementia medicines are prescribed and reviewed on the NHS by GPs and memory clinics when clinically appropriate; private review may be chosen for speed, choice or a second opinion, but the medicines and the principles behind their use are the same.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the psychiatrist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good psychiatrist will welcome every one of these.

• What benefit do you expect from this medicine, and how will we know if it is working?
• Could any current medicine now be safely reduced or stopped?
• What are the main side effects to watch for, and what should we do about them?
• If an antipsychotic is suggested, why is it needed, for how long, and what are the risks?
• Does my relative's type of dementia change which medicines are safe?
• When will the medicines next be reviewed, and who do we contact in between?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the psychiatrist who carries out my appointment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this appointment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified psychiatrist for dementia medication review

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Treatments for dementia NICE NG97 — Dementia: assessment, management and support Alzheimer's Society — Dementia medication side effects Alzheimer's Society — Antipsychotics and other drug approaches in dementia care NICE — Antipsychotics in people living with dementia (KTT7) Antipsychotic use and adverse outcomes in dementia — BMJ cohort study (PMC) nidirect — urgent and emergency care services nidirect — GP out-of-hours service NHS England — NHS 111 mental-health crisis support NHS inform Scotland — urgent mental-health help NHS 111 Wales — mental health and wellbeing nidirect — mental health emergency (Lifeline 0808 808 8000)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.