What are the common off-label and complementary therapies used for Alzheimer’s and what evidence supports them?
Executive summary
Many people with Alzheimer’s use off‑label drugs and complementary therapies alongside approved medicines; repurposed prescription agents make up about one‑third of the investigational Alzheimer’s pipeline and 11% of trials test combination approaches [1] [2]. Major medical bodies warn that most supplements and “medical foods” lack convincing Phase 3 evidence, while non‑drug therapies (exercise, cognitive training, aromatherapy, music, light stimulation) offer limited symptomatic benefits backed by mixed meta‑analyses [3] [4] [5].
1. Off‑label prescription drugs: pragmatic, common, but uneven evidence
Clinicians commonly prescribe medications off‑label to manage neuropsychiatric symptoms—antidepressants, anxiolytics, mood stabilizers and atypical antipsychotics—for agitation, aggression, depression and insomnia in people with Alzheimer’s, because only a handful of agents have formal dementia indications [6]. Repurposing of established drugs is a deliberate research route: roughly one‑third of agents in the 2025 Alzheimer’s clinical pipeline are repurposed drugs, reflecting both practical access to known agents and the field’s search for new mechanisms [1]. Evidence for benefit depends on the drug class and indication: memantine and cholinesterase inhibitors remain the standard symptomatic drugs but show only modest benefits and do not alter long‑term disease course [7].
2. GLP‑1s, diabetes drugs and cancer agents: hopeful signals, ongoing trials
Investigational work and large trials are testing diabetes drugs—GLP‑1 receptor agonists such as semaglutide—in people with Alzheimer’s or at risk, and results from major trials are expected to clarify whether these widely used drugs provide cognitive benefit [8]. Similarly, computational repurposing studies have flagged some cancer drugs as potential candidates and retrospective record analyses suggested lower Alzheimer’s incidence in some treated populations; these are preclinical or early‑stage signals, not clinical proof [9] [10]. Available sources do not mention routine clinical endorsement for these agents; trials are the arbiter of efficacy [8] [9].
3. “Medical foods,” supplements and herbal therapies: popular but medically weak
Products marketed as “medical foods” (for example formulations based on caprylic acid) and many supplements—omega‑3s, phosphatidylserine, ginkgo biloba, curcumin/turmeric, coconut oil—remain widely used by patients despite inconclusive or negative trial evidence. Regulatory and expert groups caution that there is little high‑quality Phase 3 evidence to support these claims and that some marketed medical foods avoided rigorous testing [3] [11]. Clinical trials of DHA (an omega‑3) showed no overall benefit in mild‑to‑moderate Alzheimer’s, with only tentative subgroup signals; phosphatidylserine lacks current recommendation from experts because evidence is weak [3].
4. Complementary non‑pharmacological therapies: symptom relief with limited durability
Non‑drug approaches—exercise, cognitive training, music therapy, aromatherapy, massage and light or electrical stimulation—are repeatedly recommended as complementary care. Meta‑analyses and reviews find modest improvements in mood, agitation, quality of life or short‑term cognition for some interventions, but none reliably slow neurodegeneration [4] [12]. National charities and guideline panels urge cautious use: these therapies can help symptoms without systemic drug side effects, but evidence quality is variable and benefits are often small or inconsistent [13] [14].
5. Risks, interactions and regulatory context
“Natural” does not mean risk‑free: supplements can interact with prescription drugs, and medical foods escape the rigorous trials required for drug approval—raising concerns about safety claims and marketing [6] [3]. New disease‑modifying anti‑amyloid antibodies have shifted the treatment landscape and require biomarker confirmation and MRI monitoring—illustrating how high regulatory thresholds for proven benefit contrast sharply with the low bar for alternative products [15] [16].
6. How families and clinicians should weigh options
Experts recommend prioritizing proven symptomatic and disease‑modifying options for eligible patients, discuss off‑label prescriptions for behavioural symptoms only after risk/benefit assessment, and treat complementary therapies as adjunctive measures whose goals are symptom relief and quality of life rather than disease reversal [7] [6] [4]. Major research agendas continue to test repurposed drugs and combination therapies; the pipeline includes dozens of trials aiming to validate or refute promising off‑label candidates [1] [2].
Limitations: this summary relies on the provided sources, which emphasize 2024–2025 trial landscapes and guideline statements; available sources do not mention long‑term safety profiles for many off‑label uses or definitive clinical outcomes for GLP‑1s and several repurposed cancer agents pending trial results [8] [9].