Behavioral and neuro-psychiatric symptoms of dementia can be extremely challenging and distressing for patients and their caregivers. Antipsychotic medications may be the only option if the patient's behavior is potentially harmful to him- or herself or to others.
Antipsychotic medications are often prescribed for dementia patients in nursing homes to alleviate the agitation, aggression or psychotic behavior that is either distressing to the patient or makes the patient a danger, but the Food and Drug Administration (FDA) has not approved any drugs for the treatment of behavioral symptoms of dementia. What's more, antipsychotics carry an FDA black box warning that older patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death.
Drugs versus alternatives
There are ways to deal with difficult dementia patients that don't involve the use of drugs. Once a medical cause has been ruled out, the nursing and medical staff should look for environmental triggers that can be avoided or minimized.
- Changes in the environment might include increasing contact with caregivers, switching roommates, adjusting the temperature in the room or providing stimulating activities.
- Simply paying attention to a patient can often ease disruptive symptoms.
- In some cases, difficult behavior can be safely managed by reducing boredom -- providing intellectual and physical stimulation, exercise, calming music or pet therapy.
However, if someone is in psychological agony and nondrug approaches have failed, medication might help. The risks and benefits of prescribing antipsychotics to people with dementia need to be carefully considered. While dementia patients are difficult to care for, even when drugs are administered, the practice of overmedication to make patients "manageable" is certainly not acceptable.
Advocating for your loved one with dementia
When someone with dementia is cared for in an Alzheimer's care facility, the support of family and friends is still critical, since the person can't adequately advocate on his or her own part. Family members must learn about the medications that are being dispensed, the reasons for their use, proper dosages and possible side effects.
If you notice that your loved one seems to be showing greater confusion after starting a drug, say something. Bring this to the attention of the doctor who prescribed the medication and discuss what steps can be taken to improve his or her quality of life. By maintaining this dialogue, you will be doing everything you can to ensure the best care for your loved one.Johns Hopkins Health Alert