Alzheimer's Medication Comparison: What Works, What Doesn't, and Why

When it comes to Alzheimer's medication, prescription drugs used to slow cognitive decline in people with Alzheimer’s disease. Also known as dementia drugs, these aren't cures—but for many families, they're the only tools that offer a moment of clarity, a few more months of recognition, or a quieter night. Unlike heart meds or diabetes pills, Alzheimer's drugs don't fix the brain damage. They tweak the chemicals that help neurons talk to each other. That’s why some people feel better for a while, and others don’t notice a thing.

There are just a handful of FDA-approved options, and they fall into two main groups. The first are cholinesterase inhibitors, drugs that boost acetylcholine, a brain chemical that fades in Alzheimer’s. This group includes donepezil, rivastigmine, and galantamine. They’re usually tried first, especially in early to mid-stage cases. The second group is memantine, a drug that blocks excess glutamate, a chemical that can overstimulate and kill brain cells. It’s often used in moderate to late-stage Alzheimer’s, sometimes paired with a cholinesterase inhibitor. These aren’t interchangeable. You can’t swap memantine for donepezil and expect the same result. One helps with memory signals, the other protects against nerve damage. And neither works the same for everyone.

Side effects are real. Nausea, dizziness, fatigue—these are common with cholinesterase inhibitors. Memantine can cause headaches or confusion. Some people stop taking them because the side effects feel worse than the disease. Others stick with them because even a small improvement—like remembering a grandchild’s name or staying calm during dinner—makes a difference. What matters isn’t just the drug, but the person taking it. Age, other health issues, liver function, and even what other meds they’re on all change how these drugs behave.

There’s no magic pill. No one-size-fits-all. That’s why comparing them isn’t about picking the "best"—it’s about matching the right one to the right person at the right time. Some families get lucky and find a drug that gives them six extra months of connection. Others try two or three before finding anything that helps. And some never find a match at all. The goal isn’t to reverse Alzheimer’s. It’s to hold on to what’s left—for as long as you can.

Below, you’ll find real comparisons, patient experiences, and hard truths about what these drugs can and can’t do. No fluff. No hype. Just what actually works—and what doesn’t—based on the latest data and the stories of people living with this disease every day.