Dementia & Alzheimer's:
Symptoms, Medications & Help for Family Members

At a glance

Affected in Germany ~1.8 million; worldwide over 55 million; 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 significantly from around 65
Prevention According to the 2024 Lancet Commission, ~45% of dementia risk is potentially addressable 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-pharmacological therapy
  9. Help for family members
  10. How brite helps you
  11. FAQ
  12. Related topics

1. What is dementia?

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

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

In Germany, around 1.8 million people live with dementia according to estimates from the German Alzheimer's Society; roughly 300,000 new cases occur each year.³ According to the WHO, dementia is among the leading causes of death in old age worldwide.²

2. Common forms of dementia

~60–70% Alzheimer's disease

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

~15–20% Vascular dementia

The second most common form. It generally results from impaired blood supply to the brain (e.g. after strokes or due to chronic vascular changes). Often a stepwise course. 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 hypersensitivity With Lewy body dementia, special caution is needed when using antipsychotics — professional societies warn of neuroleptic hypersensitivity.
Special form Frontotemporal dementia

Here, personality and behavior changes are typically prominent — with less emphasis on memory problems. Common symptoms: disinhibition, apathy, language disturbances. Affects relatively often younger patients and is initially often misinterpreted as depression or another psychiatric condition.

3. Symptoms by stage

Early stage (mild dementia)

Those affected are usually still largely independent at this stage but often stand out through increasing everyday problems:

  • Forgetfulness for recent events — e.g. misplaced objects, repeated questions, forgotten appointments
  • Concentration problems — difficulties with complex tasks (e.g. finances, cooking from a recipe)
  • Word-finding difficulties
  • Temporal orientation problems (e.g. confusing the day of the week or the date)
  • Loss of interest in hobbies, social withdrawal
  • Mood swings, irritability, anxiety — often the first signs noticed by family members

Middle stage (moderate dementia)

  • Marked memory impairment — older memories can also be affected
  • Loss of orientation even in familiar surroundings
  • Increasing difficulty with daily activities (e.g. dressing, personal hygiene, cooking)
  • Behavioral changes: restlessness ("wandering"), aggression, delusions, suspiciousness
  • Sleep disturbances, sometimes day–night reversal
  • Help with taking medications generally becomes necessary — missed medication becomes more frequent

Late stage (severe dementia)

  • Close family members are often no longer recognized
  • Extensive care needs in daily life
  • Severely impaired communication — often only a few words, with nonverbal cues becoming 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 — and conversely, people with dementia are at increased risk of depression. Both conditions can show similar symptoms (lack of drive, problems with concentration, withdrawal). Depression is in many cases treatable — so if there's any suspicion, medical assessment is important.

4. Distinction: normal forgetfulness vs. dementia

Often still normal (age-related)Warning signs (possible dementia)
A name doesn't come to mind immediately but comes back later Whole conversations or events are forgotten
The key gets misplaced and is later found again Familiar activities can no longer be performed
A detail of a conversation is lost Orientation in time or place is increasingly lost
Sometimes a moment is needed to get one's bearings Marked personality changes (suspiciousness, withdrawal, aggression)
Family members notice changes that the person themselves does not see
Table scrolls to the right
Rule of thumb When family members are repeatedly worried, the next step should be a visit to the GP or a memory clinic. Those affected often don't notice the changes themselves or play them down.

5. Risk factors and prevention

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

Not modifiable

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

Modifiable — what you can do (Lancet 2024)⁴

  • Treat high blood pressure consistently — particularly in middle age
  • Control elevated LDL cholesterol in middle age
  • Manage Type 2 diabetes well
  • Treat hearing loss early (hearing aids!) — according to the Lancet Commission, one of the largest modifiable individual factors
  • Avoid untreated vision loss (regular eye examinations)
  • Regular physical exercise
  • 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 seek treatment
  • Reduce alcohol, quit smoking
  • Avoid head injuries where possible (e.g. helmet when cycling)
  • Address obesity in middle age
It is usually not too late A healthy lifestyle — particularly in middle age — is currently considered the best known dementia prevention. Even in older age, the brain and everyday functioning often benefit from exercise, social contact and mental activity.⁴

6. Diagnosis

An early diagnosis is generally important — it enables access to therapies (including the new anti-amyloid antibodies), legal planning and better predictability for family members. There is also a smaller share of dementia syndromes that are in principle reversible.¹

Basic assessment (GP)

  • Cognitive screening tests: e.g. MMSE, MoCA, Clock Drawing Test — usually take only a few minutes
  • Medical history including a family member: Often at least as important as the test itself — family members frequently notice changes the affected person does not perceive
  • Lab tests: e.g. thyroid values (TSH), vitamin B12, folate, complete blood count, kidney and liver values, blood glucose — among other things to rule out reversible causes
  • Imaging: MRI or CT of the head — can help to detect other causes (e.g. tumor, normal-pressure hydrocephalus, vascular changes)

Extended assessment (neurology / memory clinic)

  • Neuropsychological testing: more detailed evaluation of various cognitive domains
  • Lumbar puncture: analysis of biomarkers in the cerebrospinal fluid (amyloid-beta-42, tau). Part of the prerequisites before anti-amyloid therapy.¹
  • Amyloid PET: imaging 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): required before therapy with anti-amyloid antibodies. Homozygous APOE4 carriers are currently excluded.⁵
Don't overlook reversible dementia syndromes A share of dementia syndromes can in principle be (partially) reversible — e.g. with vitamin B12 deficiency, hypothyroidism, normal-pressure hydrocephalus, depression ("pseudodementia") or pronounced medication side effects. That's why a thorough workup is particularly important.¹

Learn more: Preparing for a doctor's appointment.

7. Medications: symptomatic and disease-modifying

Which medication is appropriate in the individual case is always decided by your treating doctor — generally in coordination with a neurology or geriatric practice or a memory clinic.

Symptomatic therapy (established for years)

Acetylcholinesterase inhibitors (AChE inhibitors)
Drugs: Donepezil, rivastigmine (also as a patch), galantamine
Indication: Mostly 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 — gradual dose escalation as directed by a doctor often helps¹
Memantine
Indication: Generally for moderate to severe Alzheimer's dementia (NMDA receptor antagonist)
Combination: Can in practice 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. Learn more: Medication interactions.

Disease-modifying therapy (new since 2025)

For the first time: medications that target the cause With the anti-amyloid antibodies, since 2025 medications have for the first time been available in Germany that target a presumed biological cause of Alzheimer's disease — the amyloid deposits in the brain. They are only an option 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 in 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 monitoring required
German G-BA decision 2026-02-19: No proven additional benefit over the previous standard of care — price negotiations with the manufacturer are ongoing. The EU marketing authorization and availability in Germany are unaffected.⁵˒⁷
Donanemab (Kisunla)
The second anti-amyloid antibody approved in the EU. Like lecanemab, only intended for early-stage Alzheimer's disease and under similar prerequisites. ARIA are also a relevant side effect here. Benefit assessment by the German G-BA / IQWiG is ongoing (as of spring 2026).⁶
Important: only for early-stage disease — and only for few Both anti-amyloid antibodies are approved exclusively for early-stage Alzheimer's disease — not for moderate or severe dementia. Per current estimates, only a few hundred people in Germany are currently eligible for therapy with lecanemab. Annual therapy costs are reported by insurers as being in the mid five-figure range per person.⁷

Co-medications

  • Antidepressants: Depression is a common comorbidity in dementia. SSRIs are generally preferred; tricyclic antidepressants are usually considered unsuitable in dementia because of their anticholinergic action.
  • Antipsychotics: Considered only for pronounced agitation, aggression or delusional symptoms — and only when non-pharmacological measures are not sufficient. In dementia, certain antipsychotics carry an increased risk of stroke. Particular caution applies in Lewy body dementia.¹
  • Anticholinergic medications: Several commonly used drugs (e.g. certain bladder medications, older antihistamines, tricyclic antidepressants) can additionally worsen cognition in dementia. A regular medication check is particularly important in dementia. Learn more: Medication interactions.

8. Non-pharmacological therapy

Non-pharmacological measures are generally at least as important as medications in dementia — and for behavioral symptoms they are often the more effective option.¹

  • Cognitive and everyday-oriented stimulation (e.g. reminiscence therapy with photos and music from one's youth)
  • Physiotherapy — maintain mobility, prevent falls
  • Occupational therapy — support independence in daily life, adapt the living environment, use assistive devices
  • Music therapy — emotionally stabilizing; music from one's youth can elicit responses even in late stages
  • Structured daily routine — fixed times, routines and familiar surroundings generally provide a sense of security
  • Empathic communication (e.g. Validation therapy) — take the emotional world seriously, don't lecture
  • Regular exercise — has been shown in studies to slow cognitive decline
  • Light therapy — can be considered for sleep disturbances and day–night reversal
  • Sensory approaches (e.g. aromatherapy, Snoezelen) — particularly in advanced stages

9. Help for family members and caregivers

Dementia generally affects not only the person with the illness but the whole family. Family caregivers have a significantly elevated risk of exhaustion, depression and physical complaints. It's usually wise to seek support early.

Possible benefits and supports (German long-term care system)

  • Apply for a care level (Pflegegrad) with the statutory long-term care fund — dementia alone can justify a care level
  • Substitute care (Verhinderungspflege) — for times when the main caregiver is unavailable
  • Short-term inpatient care (Kurzzeitpflege) — temporary residential care
  • Day care (Tagespflege) — professional care during the day, evenings and nights at home
  • Relief allowance (Entlastungsbetrag) for recognized care and relief services
  • Care allowance (Pflegegeld, for home care by family members) or care services in kind (Pflegesachleistungen, via an outpatient care service)
Note for non-German readers The benefits listed above are part of Germany's statutory long-term care insurance (Pflegeversicherung). Similar — but not identical — structures exist in other countries (e.g. Medicare/Medicaid in the US, NHS continuing healthcare and local-authority care in the UK). Speak to your local health and social services about the equivalents in your country.

Advice and support services

  • German Alzheimer's Society (Deutsche Alzheimer Gesellschaft) — advice and information (deutsche-alzheimer.de). International equivalents include Alzheimer's Association (US) and Alzheimer's Society (UK).
  • Pflegestützpunkte (care support centers) — free advice in many German cities and counties
  • Self-help groups for family members — personal exchange (also online)
  • Dementia-friendly shared housing and supported living groups as an alternative to traditional nursing homes

Take care of yourself

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

Legal planning — start early!

  • Power of attorney (Vorsorgevollmacht in Germany) — sets out who is authorized to make decisions in an emergency
  • Advance directive / living will (Patientenverfügung in Germany) — specifies which medical measures are wanted or refused
  • Care directive (Betreuungsverfügung in Germany) — names a preferred court-appointed guardian if one is needed
Act early These documents should generally be drawn up while the affected person still has the capacity to consent. Later in the course, that is often no longer possible. Specific document types and legal requirements vary by country — consult a local legal advisor.

How brite helps you with dementia

brite supports patients and family caregivers — from daily medication reminders to the doctor's appointment.

  • Medication reminders — donepezil, rivastigmine patch, memantine, blood pressure medication: brite reliably reminds you — family caregivers can be looped in too. Set up a reminder
  • Interaction check — check dementia medications in combination with antidepressants, blood pressure drugs or anticholinergics. Check now
  • Digital medication plan — all medications clearly laid out for neurology, GP, home care service and emergency department. Go to medication plan
  • Health tracking — document cognitive changes, behavior, mood and sleep in a structured way — useful for the doctor's appointment. Track your history
Get started for free
brite app

FAQ: Common questions about dementia

Most forms of dementia are not curable according to current knowledge. A smaller share of dementia syndromes can be reversible (e.g. with vitamin B12 deficiency, hypothyroidism or normal-pressure hydrocephalus) — that's why a thorough workup 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, at delaying decline, but do not cure the condition.¹˒⁵
"Dementia" is the umbrella term for a syndrome. Alzheimer's is the most common cause of dementia at around 60–70%. Other forms include vascular dementia, Lewy body dementia and frontotemporal dementia. The course and treatment differ depending on the form.
Lecanemab is an anti-amyloid antibody, EU-approved since April 2025 and available in Germany since September 2025. It is only an option for a narrowly defined group: adults with confirmed Alzheimer's pathology in early-stage disease who are APOE4 non-carriers or heterozygous APOE4 carriers. The goal is generally to slow decline, not to cure. The German G-BA found on 2026-02-19 no proven additional benefit over the previous standard of care — price negotiations are ongoing. The EU marketing authorization and availability in Germany are unaffected.⁵˒⁷
According to the Lancet Commission (2024), around 45% of dementia risk is potentially addressable through 14 modifiable factors — including hearing loss, high LDL cholesterol in middle age, 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 family members notice the changes. Early assessment is important to rule out reversible causes, to clarify access to possible therapies and to put legal arrangements in place in time.
This is common — people with early dementia often don't have full insight into their illness (anosognosia). Usually helpful: no reproaches, "frame" the doctor visit as a routine check-up, inform the GP in advance, be patient and get support for yourself (e.g. from the German Alzheimer's Society or your country's equivalent).³
Anticholinergic medications — e.g. certain bladder medications, older antihistamines, tricyclic antidepressants or some sleep medications — can additionally worsen cognition in dementia. A regular medication review is therefore particularly important. The decision about any changes is always made by the treating doctor.
As soon as the affected person regularly needs help with daily life, an application for a care level (Pflegegrad in Germany) is generally worthwhile. Dementia alone can justify a care level. The care level determines which benefits long-term care insurance covers (e.g. care allowance, care services in kind, day care or short-term inpatient care). Other countries have different but analogous systems.

12. Related topics

Medication in older adults Polypharmacy Missed medication Medication interactions Keeping a medication list Hypothyroidism Type 2 Diabetes

Sources

  1. S3 Guideline on Dementias (DGPPN, DGN, German Alzheimer's Society and others), AWMF reg. no. 038-013, as of 2025. awmf.org
  2. WHO: Dementia — Fact Sheet. who.int
  3. German Alzheimer's Society (Deutsche Alzheimer Gesellschaft): Information, advice and figures on dementia in Germany. 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) in early Alzheimer's disease. gesundheitsinformation.de
  6. Alzheimer Forschung Initiative: Information on lecanemab and donanemab. alzheimer-forschung.de
  7. German Federal Joint Committee (G-BA): Benefit assessment for lecanemab (early Alzheimer's disease), decision 2026-02-19. g-ba.de
Medical disclaimer: This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. Choice of medication, dosing and the indication for specific therapies (such as anti-amyloid antibodies) are always determined individually by the treating doctors — generally in specialized centers. If dementia is suspected, see your GP or a memory clinic. Legal planning documents (power of attorney, advance directive, care directive) should be drawn up early. Last updated: April 2026.