An estimated 982,000 people in the United Kingdom are living with dementia, according to Alzheimer's Research UK, a figure projected to exceed 1.4 million by 2040. As the condition progresses and medication regimens grow more complex, community pharmacists are increasingly central to supporting both patients and the family members who care for them.

The pharmacy touchpoint

People with dementia visit their community pharmacy frequently — for repeat prescriptions, over-the-counter purchases and, in many cases, simply because the pharmacy is a familiar, accessible place. This regularity makes pharmacists uniquely positioned to notice early changes in cognition, medication adherence and carer wellbeing that might not be apparent in a 10-minute GP consultation every few months.

The challenge is that dementia often presents gradually. A patient who begins struggling to remember whether they have taken their morning tablets, or a carer who appears increasingly stressed at each visit, may not volunteer this information unless asked.

Medication compliance aids

Multi-compartment compliance aids (MCAs) — commonly known as dosette boxes or blister packs — are one of the most visible pharmacy interventions for dementia patients. They organise medicines by day and time, reducing the cognitive load of managing multiple medications.

When MCAs help:

• Patients in the early to moderate stages of dementia who are still living independently or with minimal support
• Medication regimens involving three or more daily doses
• Where a carer can supervise that the compartments are being emptied on schedule

When MCAs may not be enough:

• Advanced dementia where the patient cannot recognise or open the device
• When liquid medicines, inhalers or patches are part of the regimen (these cannot go in a blister pack)
• Where there is no carer to check adherence

Pharmacists should review the suitability of MCAs regularly. A compliance aid that worked six months ago may no longer be appropriate as the condition progresses. The NICE Guideline on managing medicines for adults receiving social care (NG67) recommends that MCAs should not be the default intervention — a medicines review assessing the overall regimen should come first.

Anticholinergic burden screening

Anticholinergic medicines — including some antihistamines, antidepressants, bladder antimuscarinics and antipsychotics — are associated with worsened cognitive function, confusion, falls and delirium in older adults. In people with dementia, the effect is compounded.

The anticholinergic burden (ACB) scale scores medicines from 0 to 3, with a cumulative score of 3 or above associated with clinically significant cognitive impairment. Common offenders that pharmacists should watch for include:

When pharmacists identify a high cumulative ACB score in a dementia patient's medication record, they should raise this with the prescriber. Alternatives often exist: solifenacin or mirabegron for bladder symptoms, cetirizine or loratadine for allergies, sertraline or citalopram for depression.

This is precisely the kind of intervention that structured medication reviews (SMRs) are designed to capture. Pharmacists conducting SMRs under the PCN contract should routinely screen for anticholinergic burden in patients with a dementia diagnosis.

Counselling patients and carers

Effective communication with dementia patients requires patience and adaptation:

• Use short, simple sentences and allow time for the patient to process
• Maintain eye contact and speak at a normal pace — not louder, slower
• Address the patient directly, not over their head to the carer
• Use visual aids or written instructions in large print where helpful
• Be consistent — the same pharmacist handling each interaction builds trust

For carers, the pharmacist may be the only healthcare professional they see regularly. Carers of people with dementia report high levels of stress, sleep deprivation and social isolation. Pharmacists can:

• Ask how the carer is managing, not just the patient
• Check whether the carer is registered with their GP practice as a carer (unlocking support services)
• Signpost to Alzheimer's Society (alzheimers.org.uk), Admiral Nurses (dementiauk.org), local carers' centres and the Carers UK helpline
• Ensure the carer knows about Carer's Allowance and Attendance Allowance — benefits that many eligible families do not claim

Donepezil, memantine and the pharmacy role

The two main drug classes for dementia symptoms in the UK are acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild-to-moderate Alzheimer's, and memantine for moderate-to-severe disease. Pharmacists should counsel on:

Donepezil: Take at bedtime (vivid dreams and insomnia are common early side effects that often settle). Monitor for bradycardia, nausea and diarrhoea. Do not crush the standard tablet — an orodispersible formulation is available.

Rivastigmine: Available as capsules, oral solution and transdermal patches. Patches reduce GI side effects. Counsel on patch site rotation and application to clean, dry, non-hairy skin.

Galantamine: Modified-release capsules should be taken with food. More GI side effects than donepezil.

Memantine: Usually well tolerated. Can cause dizziness, headache and constipation. Watch for interactions with amantadine and dextromethorphan (both NMDA-related).

Falls risk and medication review

Falls are a leading cause of hospitalisation in people with dementia. Many medicines increase falls risk — antihypertensives causing postural hypotension, benzodiazepines, z-drugs, opioids and the anticholinergics discussed above.

Pharmacists reviewing medication lists should actively consider:

• Is the blood pressure target still appropriate? Over-treatment of hypertension in frail elderly patients causes more falls than it prevents strokes
• Are there any medicines that were started years ago and never reviewed?
• Can any PRN (as-needed) sedatives be stepped down or stopped?

The NHS Long Term Plan's emphasis on structured medication reviews in care homes creates a formal role for pharmacists in exactly this work. PharmSee's job search tool shows growing demand for care home pharmacist roles — a sector where dementia expertise is increasingly expected.

Safeguarding awareness

Pharmacists should be alert to safeguarding concerns in dementia patients, including:

• Signs of neglect (unkempt appearance, weight loss, pressure sores)
• Financial abuse (a common form of elder abuse — the patient may mention money worries or someone controlling their finances)
• Unexplained bruising or injuries
• A carer who is hostile, controlling or dismissive of the patient's needs

If concerns arise, pharmacists should follow their organisation's safeguarding policy and contact the local authority safeguarding team. The GPhC expects all pharmacists to complete safeguarding training as part of their CPD.

The growing pharmacy role

With an ageing population and an NHS under sustained pressure, community pharmacists will see more dementia patients, more often. The sector already operates more than 13,000 community pharmacies in England alone, according to NHSBSA data — more accessible than GP surgeries in most areas.

For pharmacists interested in developing dementia care skills, the Centre for Pharmacy Postgraduate Education (CPPE) offers free dementia-focused learning modules. Roles in care home pharmacy and PCN clinical pharmacy, where dementia management is core, are listed on PharmSee's job board. Salary benchmarks for these roles are available in the PharmSee salary guide.

Sources: Alzheimer's Research UK prevalence data (2024); NICE NG97 Dementia: assessment, management and support for people living with dementia and their carers (2018, reviewed 2024); NICE NG67 Managing medicines for adults receiving social care (2017); Anticholinergic Burden Scale (Boustani et al., 2008); NHS Long Term Plan (2019); NHSBSA dispensing contractor records.