Dementia & Alzheimer's: Symptoms, Medications & Help for Caregivers

At a glance

Affected in Germany ~1.8 million; over 55 million worldwide; approx. 300,000 new cases per year in Germany
Most common form Alzheimer's disease (around 60–70% of all dementias)
Main risk factor Age — risk rises markedly from about 65 onward
Prevention Per the Lancet Commission 2024, ~45% of dementia risk is potentially modifiable through lifestyle factors
Medications Donepezil, rivastigmine, galantamine, memantine; NEW: lecanemab (Leqembi, since 09/2025), donanemab (Kisunla)
ICD-10 F00–F03, G30

Table of contents

  1. What is dementia?
  2. Common forms of dementia
  3. Symptoms by stage
  4. Forgetfulness vs. dementia
  5. Risk factors and prevention
  6. Diagnosis
  7. Medications
  8. Non-drug therapy
  9. Help for caregivers
  10. How brite helps you
  11. FAQ
  12. Related topics

1. What is dementia?

Dementia is usually not a single disease but a syndrome — a cluster of symptoms that can be caused by various brain disorders. It is typically marked by a progressive decline in cognitive abilities that goes beyond normal aging and increasingly affects everyday life.²

Commonly affected are: memory (especially short-term memory), thinking and judgment, orientation in time and space, language (word-finding, sentence structure), planning of actions, and recognizing people and objects.

According to estimates by the German Alzheimer's Association (Deutsche Alzheimer Gesellschaft), around 1.8 million people in Germany live with dementia; about 300,000 new cases are added each year.³ According to the WHO, dementia is among the leading causes of death in older age worldwide.²

2. Common forms of dementia

~60–70% Alzheimer's disease

The most common form. Deposits of amyloid plaques and tau fibrils in the brain contribute to the death of nerve cells. Onset is usually gradual, with short-term memory problems; the course is generally slow and extends over many years. New since 2025: In Germany, a disease-modifying therapy with anti-amyloid antibodies is now available for the first time for a narrowly defined group of patients (see section 7).¹

~15–20% Vascular dementia

The second most common form. It usually results from circulatory problems in the brain (e.g., after strokes or due to chronic vascular changes). The course is often stepwise. Prevention: consistent treatment of high blood pressure, diabetes and other cardiovascular risk factors.

~5–10% Lewy body dementia

Typical features are fluctuating cognitive performance (good and bad days), visual hallucinations and Parkinson-like symptoms.¹

Important: neuroleptic sensitivity In Lewy body dementia, particular caution is needed when using antipsychotics — professional societies warn of a neuroleptic sensitivity.
Special form Frontotemporal dementia

Here, changes in personality and behavior are usually in the foreground — with fewer memory problems. Common symptoms: disinhibition, apathy, language disorders. It affects comparatively often younger patients and is initially frequently misinterpreted as depression or another mental illness.

3. Symptoms by stage

Early stage (mild dementia)

At this stage, affected people are usually still largely independent but often stand out through increasing everyday problems:

  • Forgetfulness about recent events — e.g., misplaced objects, repeated questions, forgotten appointments
  • Concentration problems — difficulty with complex tasks (e.g., finances, cooking from a recipe)
  • Word-finding difficulties
  • Problems with orientation in time (e.g., confusing the day of the week or the date)
  • Declining interest in hobbies, social withdrawal
  • Mood swings, irritability, anxiousness — often the first signs that relatives notice

Middle stage (moderate dementia)

  • Marked memory impairment — older memories can also be affected
  • Loss of orientation even in familiar surroundings
  • Increasing difficulties with everyday activities (e.g., dressing, personal hygiene, cooking)
  • Behavioral changes: restlessness ("wandering"), aggression, delusions, suspicion
  • Sleep disturbances, sometimes day-night reversal
  • Help with taking medication is usually needed — forgetting medications becomes more frequent

Late stage (severe dementia)

  • Close family members are often no longer recognized
  • Comprehensive need for care in everyday life
  • Severely limited communication — often only a few words; nonverbal signals become more important
  • Physical symptoms: inability to walk, incontinence, swallowing difficulties
  • Increased susceptibility to infections (e.g., pneumonia)
Dementia and depression Dementia and depression are often closely linked: depression can be an early sign of dementia — conversely, people with dementia have an increased risk of depression. Both conditions can show similar symptoms (lack of drive, concentration problems, withdrawal). Depression is treatable in many cases — so if it is suspected, a medical evaluation should always take place.

4. Telling them apart: normal forgetfulness vs. dementia

Often still normal (age-related)Warning signs (possible dementia)
A name doesn't come to mind right away but returns later Entire conversations or events are forgotten
Keys are misplaced and found again later Familiar tasks can no longer be carried out
A detail of a conversation is lost Orientation in time or place is increasingly lost
Sometimes you need a moment to get your bearings Marked personality changes (suspicion, withdrawal, aggression)
Relatives notice changes that the affected person themselves does not see
Table scrollable to the right
Rule of thumb If relatives are repeatedly worried, it's worth seeing the family doctor or a memory clinic. Affected people themselves often don't notice the changes or play them down.

5. Risk factors and prevention

In its 2024 update, the Lancet Commission on dementia identified a total of 14 potentially modifiable risk factors that together are held responsible for about 45% of all dementia cases. The largest individual factors are hearing loss and high LDL cholesterol in midlife (each around 7%).⁴

Not modifiable

  • Age — by far the most important risk factor
  • Genetics: in particular the APOE4 gene; also, among others, Down syndrome
  • Family history: first-degree relatives with dementia can increase one's own risk

Modifiable — what you can do (Lancet 2024)⁴

  • Treat high blood pressure consistently — especially in midlife
  • Control elevated LDL cholesterol in midlife
  • Manage type 2 diabetes well
  • Treat hearing loss early (hearing aids!) — according to the Lancet Commission, one of the largest modifiable single factors
  • Avoid untreated vision loss (regular eye exams)
  • Regular physical activity
  • Maintain social contacts — loneliness and social isolation are considered risk factors
  • Stay mentally active (e.g., reading, puzzles, learning languages, practicing new skills)
  • Take depression seriously and have it treated
  • Reduce alcohol, stop smoking
  • Avoid head injuries where possible (e.g., wear a helmet when cycling)
  • Address obesity in midlife
It's usually not too late A healthy lifestyle — especially in midlife — is currently considered the best known dementia prevention. Even in older age, the brain and everyday life often benefit from exercise, social contacts and mental activity.⁴

6. Diagnosis

Early diagnosis is usually important — it enables access to therapies (including the new anti-amyloid antibodies), legal precautions, and better planning for relatives. In addition, there is a smaller proportion of dementia syndromes that are, in principle, reversible.¹

Basic work-up (family doctor)

  • Cognitive screening tests: e.g., MMSE, MoCA, clock-drawing test — usually take only a few minutes
  • History-taking with relatives: often at least as important as the test itself — relatives frequently notice changes that the affected person does not perceive
  • Laboratory tests: e.g., thyroid values (TSH), vitamin B12, folic acid, blood count, kidney and liver values, blood sugar — among other things to rule out reversible causes
  • Imaging: MRI or CT of the head — can help identify other causes (e.g., tumor, normal-pressure hydrocephalus, vascular changes)

Extended work-up (neurology/memory clinic)

  • Neuropsychological testing: a more detailed assessment of various cognitive areas
  • Lumbar puncture: analysis of biomarkers in the cerebrospinal fluid (amyloid-beta-42, tau). Part of the prerequisites before anti-amyloid therapy.¹
  • Amyloid PET: an imaging procedure that can directly visualize amyloid deposits. Not available everywhere.
  • Blood tests (in development): newer blood tests can detect amyloid-related markers — increasingly used in specialized centers.
  • Genetics (APOE): intended before therapy with anti-amyloid antibodies. Homozygous APOE4 carriers are currently excluded.⁵
Don't overlook reversible dementia syndromes Some dementia syndromes can, in principle, be (partly) reversible — e.g., with vitamin B12 deficiency, hypothyroidism, normal-pressure hydrocephalus, depression ("pseudodementia") or pronounced medication side effects. That is why a thorough work-up is particularly important.¹

More: Preparing for a doctor's appointment.

7. Medications: symptomatic and disease-modifying

Which medication makes sense in an individual case is always decided by the treating physician — usually in coordination with a neurology or geriatrics practice or a memory clinic.

Symptomatic therapy (established for years)

Acetylcholinesterase inhibitors (AChE inhibitors)
Active ingredients: donepezil, rivastigmine (also as a patch), galantamine
Indication: usually mild to moderate Alzheimer's dementia
Mechanism: support signal transmission between nerve cells by inhibiting the breakdown of acetylcholine
Effect: generally moderate on the cognitive course
Side effects: nausea, diarrhea, loss of appetite, dizziness — often helpful: gradual dose titration as directed by the physician¹
Memantine
Indication: usually in moderate to severe Alzheimer's dementia (NMDA receptor antagonist)
Combination: in practice can also be combined with an AChE inhibitor
Side effects: dizziness, headache, constipation, drowsiness¹
Ginkgo biloba
Standardized plant extract. The evidence is mixed; some patients subjectively report a positive effect. Caution with concurrent use of blood thinners. More: Drug interactions.

Disease-modifying therapy (new since 2025)

For the first time: medications that target the cause With the anti-amyloid antibodies, since 2025 there have been medications in Germany for the first time that target a presumed biological cause of Alzheimer's disease — the amyloid deposits in the brain. They are an option only for a narrowly defined group and are used exclusively in specialized centers.
Lecanemab (Leqembi) — NEW since September 2025 in Germany
EU approval: April 2025 · Available in Germany: September 2025
Indication: adults with confirmed Alzheimer's pathology at the stage of mild cognitive impairment (MCI) or mild Alzheimer's dementia, who are APOE4 non-carriers or heterozygous APOE4 carriers
Goal: generally to slow cognitive decline — not a cure
Side effects: ARIA (Amyloid-Related Imaging Abnormalities) — regular MRI checks are required
G-BA decision 19 Feb 2026: no proven added benefit compared with the previous standard of care — price negotiations with the manufacturer are ongoing. EU approval and availability in Germany remain unaffected.⁵˒⁷
Donanemab (Kisunla)
The second anti-amyloid antibody approved in the EU. Like lecanemab, it is intended only for the early stage of Alzheimer's disease and under similar prerequisites. Here too, ARIA is a relevant side effect. Benefit assessment by the G-BA/IQWiG is ongoing (as of spring 2026).⁶
Important: only for the early stage — and only for a few Both anti-amyloid antibodies are approved exclusively for the early stage of Alzheimer's disease — not for moderate or severe dementia. According to current estimates, only a few hundred people in Germany are currently eligible for therapy with lecanemab. Annual treatment costs are stated by health insurers to be in the order of a mid five-figure sum per person.⁷

Concomitant medication

  • Antidepressants: depression is a common comorbidity in dementia. SSRIs are usually preferred; tricyclic antidepressants are generally considered unsuitable in dementia because of their anticholinergic effect.
  • Antipsychotics: only considered for pronounced agitation, aggression or delusional symptoms — and only when non-drug measures are not sufficient. In dementia, certain antipsychotics carry an increased risk of strokes. In Lewy body dementia, particular caution applies.¹
  • Anticholinergic medications: some common active ingredients (e.g., certain bladder medications, older antihistamines, tricyclic antidepressants) can additionally worsen cognition in dementia. A regular medication check is particularly important in dementia. More: Drug interactions.

8. Non-drug therapy

Non-drug measures are usually at least as important as medications in dementia — for behavioral symptoms, often the more effective option.¹

  • Cognitive and everyday-oriented support (e.g., biography work with photos and music from one's youth)
  • Physiotherapy — maintain mobility, prevent falls
  • Occupational therapy — support independence in everyday life, adapt living space, use aids
  • Music therapy — emotionally stabilizing; music from one's youth can elicit reactions even in the late stage
  • Structured daily routine — fixed times, routines and familiar surroundings usually provide security
  • Empathetic communication (e.g., validation) — take the emotional world seriously, don't lecture
  • Regular exercise — can slow cognitive decline in studies
  • Light therapy — may be considered for sleep disturbances and day-night reversal
  • Sensory offerings (e.g., aromatherapy, Snoezelen) — especially in advanced stages

9. Help for relatives and caregivers

Dementia usually affects not only the person who is ill but the whole family. Caregiving relatives have a markedly increased risk of exhaustion, depression and physical complaints. It is usually wise to seek support early.

Possible benefits and support

  • Apply for a care level (Pflegegrad) with the long-term care insurance fund (Pflegekasse) — dementia alone can also justify a care level (both are German statutory long-term care terms)
  • Respite care (Verhinderungspflege) — for times when the main caregiver is unavailable (German statutory benefit)
  • Short-term care (Kurzzeitpflege) — temporary inpatient accommodation (German statutory benefit)
  • Day care (Tagespflege) — professional care during the day, at home in the evenings and at night
  • Relief allowance (Entlastungsbetrag) for recognized care and relief services (German statutory benefit)
  • Care allowance (Pflegegeld, for home care by relatives) or care benefits in kind (Pflegesachleistungen, outpatient care service)

Counseling and support services

  • German Alzheimer's Association (Deutsche Alzheimer Gesellschaft) — advice and information (deutsche-alzheimer.de)
  • Care support points (Pflegestützpunkte) — free advice in many cities and districts
  • Self-help groups for relatives — personal exchange (also online)
  • Dementia shared-living communities and assisted living groups as an alternative to the classic care home

Take care of yourself

  • Recognize your own limits — managing everything alone is usually not possible
  • Accept help (care service, day care, family)
  • Don't neglect your own health — doctor's appointments, exercise, social contacts
  • Seek psychological support when the burden becomes too great — that is not a sign of weakness

Legal precautions — early!

  • Healthcare power of attorney (Vorsorgevollmacht) — sets out who may make decisions in an emergency (German legal instrument)
  • Advance healthcare directive (Patientenverfügung) — defines which medical measures are wanted or refused
  • Care directive (Betreuungsverfügung) — names the desired legal guardian/representative
Act early These documents should usually be drawn up while the affected person is still capable of giving consent. Later in the course, this is often no longer possible.

How brite helps you with dementia

brite supports those affected and caregiving relatives — from the daily medication reminder to the doctor's appointment.

  • Medication reminder — donepezil, rivastigmine patch, memantine, blood pressure medication: brite reminds reliably — caregiving relatives can also be involved. Set up a reminder
  • Interaction check — check dementia medications in combination with antidepressants, blood pressure medications or anticholinergic drugs. Check now
  • Digital medication plan — all medications laid out clearly for neurology, the family doctor, the care service and the emergency department. Go to medication plan
  • Health history — document cognitive changes, behavior, mood and sleep in a structured way — helpful for the doctor's appointment. Track your history
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FAQ: Common questions about dementia

Most forms of dementia are, by current knowledge, not curable. A smaller share of dementia syndromes can be reversible (e.g., with vitamin B12 deficiency, hypothyroidism or normal-pressure hydrocephalus) — which is why a thorough work-up is important. Medications such as AChE inhibitors or memantine can generally slow the course. The new anti-amyloid antibodies (lecanemab, donanemab) aim, in a narrowly defined group, to delay decline, but do not cure the condition.¹˒⁵
"Dementia" is the umbrella term for a syndrome. Alzheimer's is, at around 60–70%, the most common cause of dementia. Other forms are, for example, vascular dementia, Lewy body dementia and frontotemporal dementia. Depending on the form, course and treatment differ.
Lecanemab is an anti-amyloid antibody, EU-approved since April 2025, available in Germany since September 2025. It is an option only for a narrowly defined group: adults with confirmed Alzheimer's pathology in the early stage who are APOE4 non-carriers or heterozygous carriers. The goal is generally to slow decline, not a cure. The G-BA found on 19 February 2026 no proven added benefit compared with the previous standard of care — price negotiations are ongoing. The EU approval and availability in Germany remain unaffected.⁵˒⁷
According to the Lancet Commission (2024), about 45% of dementia risk is potentially addressable through 14 modifiable factors — including hearing loss, high LDL cholesterol in midlife, high blood pressure, physical inactivity, smoking, alcohol, diabetes, social isolation and depressive disorders. It is usually not too late to start with preventive measures.⁴
With increasing forgetfulness, orientation problems, word-finding difficulties or personality changes — especially when relatives notice the changes. Early evaluation is important in order to rule out reversible causes, clarify access to possible therapies and arrange legal precautions in good time.
This happens frequently — people with beginning dementia often lack full insight into their illness (anosognosia). Usually helpful: no reproaches, "embed" the doctor's visit as a routine check-up, inform the family doctor beforehand, be patient and seek support for yourself (e.g., from the German Alzheimer's Association).³
Anticholinergic medications — e.g., certain bladder medications, older antihistamines, tricyclic antidepressants or some sleep aids — can additionally worsen cognition in dementia. A regular medication check is therefore particularly important. The decision about changes is always made by the treating physician.
As soon as the affected person regularly needs help in everyday life, applying for a care level (Pflegegrad) is usually worthwhile. Dementia alone can justify a care level. The care level determines which benefits the long-term care insurance fund (Pflegekasse) covers (e.g., care allowance, care benefits in kind, day or short-term care). (Pflegegrad and Pflegekasse are German statutory long-term care terms.)

12. Related topics

Medications in old age Polypharmacy Forgetting medications Drug interactions Keeping a medication list Hypothyroidism Type 2 Diabetes

Sources

  1. S3-Leitlinie Demenzen (DGPPN, DGN, Deutsche Alzheimer Gesellschaft u. a.), AWMF Reg-Nr. 038-013, Stand 2025. awmf.org
  2. WHO: Dementia — Fact Sheet. who.int
  3. Deutsche Alzheimer Gesellschaft: Informationen, Beratung und Zahlen zu Demenz in Deutschland. deutsche-alzheimer.de
  4. Livingston G. et al.: Dementia prevention, intervention, and care — 2024 report of the Lancet standing Commission. Lancet 2024; 404:572–628. thelancet.com
  5. gesundheitsinformation.de (IQWiG): Lecanemab (Leqembi) bei früher Alzheimer-Krankheit. gesundheitsinformation.de
  6. Alzheimer Forschung Initiative: Informationen zu Lecanemab und Donanemab. alzheimer-forschung.de
  7. Gemeinsamer Bundesausschuss (G-BA): Nutzenbewertungsverfahren Lecanemab (frühe Alzheimer-Krankheit), Beschluss 19.02.2026. g-ba.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. The choice of medication, dosage and the indication for special therapies (such as anti-amyloid antibodies) are always determined individually by the treating physicians — usually in specialized centers. If dementia is suspected, the family doctor or a memory clinic should be consulted. Legal precautionary documents (healthcare power of attorney, advance directive, care directive) should be drawn up early. Last updated: April 2026.