5 Types of Medication Used to Treat Difficult Dementia Behaviors

One of the most difficult difficulties in the case of Alzheimer's disease or other dementias dealing with challenging behaviour.

These are not symptoms that are related to the chronic memory/thinking disorders that are characteristic of dementia. These include issues such as:

• Delusions, paranoid behaviours or unfounded beliefs
• Aggression (getting "amped up" or "revved up") or aggressive or aggressive
• Unrestful pacing or wandering
• Uncontrolled behaviour, which is engaging in socially inappropriate things
• Sleep disturbances

These are technically known as "neuropsychiatric" manifestations, however, normal people may call them "acting insane" symptoms. They could also be "crazy-making" signs since they tend to make family caregivers crazy.

Because these behaviour patterns are challenging as well as stressful to caregivers and, often, for people who suffer from dementia -- those often inquire if there are any medications that will aid.

The simple response can be "Maybe."

The short answer is "Maybe however there could be adverse effects and other major risk factors to take into account and we must first try non-drug strategies to deal with these issues."

In reality, there is no medication that is FDA-approved to treat of these types of behaviours in Alzheimer's disease and other types of dementia. (For more information on the medications which are FDA-approved for treating the cognitive symptoms of dementia, click this link: 4 Medications to treat Alzheimer's and Other Dementias What they do and Answers to FAQs.)

It is quite typical for drugs such as antipsychotics that are prescribed "off-label" for this reason.

This can be called a "chemical restriction" (in contrast to the practice of the use of a chair to restrain people that is a "physical constraint"). Many times tranquillizing drugs are able to calm the behaviour. But they could have severe negative side effects and dangers, which are rarely discussed with families.

Most importantly, they're often prescribed too early or in large dosages, without the caregivers and doctors taking the time to discover the reason behind the behaviour and the non-pharmacological approaches that could assist.

This is why, in 2013, the American Geriatrics Society made the following suggestion as part of its "Choosing wisely" Campaign: " Don't make use of antipsychotics as your first option for treating psychological and behavioural signs associated with dementia."

You might be thinking about what is the best first option. It depends on the circumstances but generally, the first option for treating difficult behaviours is not medication. (A possible exception is that geriatricians tend to consider medications to relieve discomfort as well as constipation because these triggers are often the cause of difficult behaviours.)

In the meantime, medications should be utilized only after other non-drug strategies are tried or using non-drug methods in conjunction. (Learn more about them in this article: 7 Steps to managing difficult dementia behaviours safely and without medication.)

In some situations, it is recommended to consider medication. If your loved ones suffer from Alzheimer's disease or another form of dementia I'd like you to know how to work with doctors in the wise, prudent usage of medications to control difficult behaviour.

In this article, I'll discuss the most commonly used forms of medication that are used to treat difficult behaviour in people with dementia. I'll also describe the approach that I employ when using these drugs.

5 Types of Medication For Difficult Behaviors in Dementia

Most of the medications that are employed to treat problematic behaviour fall under any of these groups:

1. Antipsychotics. These are medicines that were initially developed for treating schizophrenia and other diseases that have psychosis symptoms. (For more information on psychosis, which is a common occurrence in later life, read the 6 causes for Paranoia in Aging and what to do.)

Commonly utilized drug: Antipsychotics often used by older people are:

• Risperidone (brand trademark name Risperdal)
• Quetiapine (brand brand name Seroquel)
• Olanzapine (brand brand name Zyprexa)
• Haloperidol (brand trademark name Haldol)
• For a more extensive list of antipsychotic medications look up this page on the NIH website.

Effects of use: Most antipsychotics are sedative and reduce aggression or agitation through the sedative effects. Antipsychotics also can reduce psychosis symptoms such as hallucinations, delusions or paranoid belief, but they aren't often able to completely eliminate these symptoms for people suffering from dementia.

The risks of using: The risks of antipsychotics can be attributed to how much dose and includes:

• Cognitive decline, as well as the potential acceleration of the cognitive decline
• Higher risk of falling
• An increased risk of stroke and death. This has been calculated as an increase in the absolute risk of 1 to 4 per cent
• The risk of adverse side effects is known in the medical community as " extrapyramidal symptoms," which include stiffness and tremors that are similar to Parkinson's disease along with a range of muscle coordination issues
• Lewy-body-related dementia sufferers or the background of Parkinsonism are more susceptible to the effects of antipsychotic medications; in these individuals, quetiapine is considered to be the safest choice.

Clinical evidence of effectiveness: Clinical studies usually show a minor improvement in the symptoms. But, it is counterbalanced by the frequent adverse effects. Research has repeatedly shown that taking antipsychotics for patients with dementia is linked with a greater risk of stroke and death.

2. Benzodiazepines. This is a class of drugs that can relax people very quickly. Therefore, these medications are used to treat anxiety, panic attacks, to help with the treatment of sedation and insomnia. They are easy to become habit-forming.

Most commonly used drugs: In older adults, these are:

• Lorazepam (brand trademark Ativan)
• Temazepam (brand trademark name Restoril)
• Diazepam (brand name Valium)
• Alprazolam (brand trademark Xanax)
• Clonazepam (brand brand name Klonopin)

Common effects: In the brain, benzodiazepines work similar to alcohol and usually induce relaxation and the feeling of sedation. They differ in the length of time they stay in the body. Alprazolam is considered to be short-acting while diazepam is long-acting.

Risks associated with use: A major risk of these drugs is that, in patients of any age, they can quickly cause psychological and physical dependence. Other risks that are more severe when older individuals are:

• Higher risk of falling
• Paradoxical Arousal (some older adults are disinhibited or become more restless when they are given these medications)
• Confusion and confusion are growing
• Causes or getting worse the symptoms of delirium
• The possibility of accelerating cognitive decline

For older people who use benzodiazepines frequently, there is an increased risk of developing dementia symptoms once the drug is cut down or completely tapered off. This is due to the fact that some people be more anxious and feel uncomfortable because of physical withdrawal which can cause a change in behaviour and thinking.

The abrupt stopping of benzodiazepines can trigger severe withdrawal symptoms that can be life-threatening, and medical supervision is required when you are reducing this type of drug. (See How You Can Help someone stop Ativan For more details.)

The evidence of effectiveness: A recent review of research conducted in clinical settings concluded that there's "limited evidence of clinical effectiveness." While these medications can have an effect when utilized, it isn't clear that they help with agitation and difficult behaviour in the majority of people. There isn't any evidence whether they're more effective than antipsychotics for long-term treatment of problems with behaviour.

3. Mood stabilizers. These are medications that are commonly prescribed for seizures. They usually decrease the "excitability" of brain cells.

Commonly prescribed medications: Valproic acid (brand name: Depakote) is one of the widely utilized medications of this kind for older adults suffering from dementia. There are both long- and short-acting formulations.

Effects of use: The effect is dependent on the dosage and the person. It could be sedating.

The dangers of using: Valproic acid requires regular checking the blood concentrations. Even if the blood level is believed to be within the acceptable limits, adverse reactions for older adults are not uncommon and can include:

• Confused or even worse thinking
• Dizziness
• Achieving balance or walking with difficulty
• Tremor, as well as the development of additional symptoms of Parkinsonism symptoms
• Gastrointestinal symptoms such as nausea, vomiting, or diarrhoea

The evidence of the clinical effectiveness: A review of randomized trials using Valproate to treat agitation in people with dementia discovered no evidence of clinical effectiveness, and described the frequency of adverse side effects to be "unacceptable." However, despite this, some psychiatrists in geriatrics and other experts believe the drug works to improve the behaviour of certain individuals suffering from dementia.

4. Anti-depressants. Many of them offer anti-anxiety properties. However, it can take several weeks or even months before it can exert its full impact on anxiety or depression symptoms.

Commonly utilized medicines: Antidepressants are often used for people who are older and suffering from dementia. They include:

• Selective serotonin reuptake inhibition (SSRI) drugs for depression: Citalopram, escitalopram, and sertraline (brand names Celexa, Lexapro, and Zoloft respectively) are frequently employed
• Paroxetine (brand code Paxil) is an additional commonly-used SSRI however since it's more anticholinergic than other SSRIs doctors of geriatrics should steer clear of the use of this medication for a patient suffering from dementia.
• Mirtazapine (brand name Remeron) is an antidepressant that may increase appetite, and can also increase sleepiness at night. It is usually administered prior to bedtime.
• Trazodone (brand name Desyrel) is a mild antidepressant that can be sedating. It is typically used prior to bed to aid in improving the quality of sleep.

Common effects: The effects of these drugs on agitation are dependent. SSRIs could help certain individuals however, it typically takes months or even longer to show any effects. For certain people, an antidepressant that is sedating at night may improve sleep, and this could reduce the irritability of the day.

The risks of using: The anti-depressants listed above are generally "well-tolerated" by older adults, particularly when they are started with small doses and slowly increasing increase as needed. The risks and adverse effects are:

• Nausea and digestive distress particularly when you first start with or increase the dose (SSRIs)
• SSRIs might be active in some individuals and can cause insomnia and agitation.
• Citalopram (in doses that are greater than 20 mg/day) may increase the possibility of sudden cardiac arrest caused by arrhythmias.
• A higher risk of falling particularly with stimulant antidepressants that are sedating.

Clinical evidence of effectiveness: A 2014 randomized study showed that citalopram resulted in some improvement in neuropsychiatric symptoms, however, the dosage used was 30 mg per day and has since been disapproved by the FDA. Other studies have suggested that antidepressants aren't very efficient in reducing symptoms of agitation.

5. Dementia drugs. These are the FDA-approved medications for treating cognitive and memory issues that come by Alzheimer's disease. In certain patients, they are believed to be able to treat some neuropsychiatric signs. For more details on their names, medications and their effectiveness look up 4 Medications for Treating Alzheimer's and Other Dementias.