5 Types of Medications for Alzheimer’s Behavior: Effectiveness, Benefits, and Risks

medications for alzheimer's behavior

Sometimes medication is needed to reduce difficult dementia behaviors

Someone with Alzheimer’s or dementia may become extremely anxious, paranoid, angry, or even aggressive.

Challenging behaviors like these worsen an older adult’s quality of life and may be too much for families to safely manage at home.

So it’s no surprise that many family caregivers ask if there are medications for Alzheimer’s behavior that can calm their older adult and improve their quality of life (and everyone else’s).

A person’s actions could be caused by boredom, frustration, fear, physical discomfort, or an overstimulating environment. So before using medication, always try non-drug techniques to reduce challenging dementia behavior.

But sometimes, even if all those problems are solved, a person’s behavior doesn’t improve and they’re clearly still in distress.

Dr. Leslie Kernisan, a San Francisco Bay Area geriatric doctor, wrote an article that explains the 5 types of medication that are used to treat difficult dementia behavior.

We’ve summarized the key points from her article here: the 5 behavioral medications, how they can reduce challenging behavior, side effects, risks, and warnings.




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5 types of medications for Alzheimer’s behavior

1. Antipsychotics
Antipsychotic medications were originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms like hallucinations, delusions, anxiety, and suspiciousness.

Commonly used drugs in older adults include:

  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)
  • Haldol (haloperidol)

Typical effects:

  • Sedating
  • Calm agitation or aggression through the sedating effects
  • Reduce symptoms like delusions, hallucinations, or paranoid beliefs (but it’s rare that they’ll be completely solved)

Risks include:

  • Increased risk of stroke and of death
  • Decreased cognitive function
  • Possible acceleration of cognitive decline
  • Increased fall risk
  • Muscle coordination problems, stiffness, and tremor (similar to Parkinson’s disease)

Important: People with Lewy body dementia or a history of Parkinsonism may be especially sensitive to antipsychotic side-effects. For those individuals, Seroquel (quetiapine) is considered the safest choice.

 

2. Benzodiazepines

These drugs tend to relax people fairly quickly so they’re used for anxiety, panic attacks, sedation, and to treat insomnia.

However, it’s possible for these medications to have an opposite effect and increase agitation. Also, they can easily be habit-forming.

Even if someone might appear sedated, it’s not clear that these meds truly improve agitation and difficult behaviors in most people. It’s also not clear that they work better than antipsychotics for longer-term management of behavior problems.

Commonly used drugs in older adults include:

  • Ativan (lorazepam)
  • Restoril (temazepam)
  • Valium (diazepam)
  • Xanax (alprazolam)

Typical effects:

  • Relaxation
  • Sedation

Risks:

  • Major risk: these drugs can easily cause physical and psychological dependence
  • Increased risk of falls
  • Increased agitation, disinhibition, or restlessness
  • Increased confusion
  • Causing or worsening delirium
  • Faster cognitive decline
  • Worsening dementia symptoms after reducing or tapering off the medication (withdrawal symptoms increase anxiety and discomfort and worsen thinking and behavior)

WARNING: Stopping benzodiazepines suddenly can cause life-threatening withdrawal symptoms. A doctor’s supervision is a MUST when tapering off or stopping this type of medication.




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3. Mood-stabilizers
These are medications that are typically used for seizures. They reduce the “excitability” of brain cells.

Studies of randomized trials didn’t find this medication to be helpful and found that negative effects were worrisome.

However, some geriatric psychiatrists and other experts feel that it can work well to improve behavior in certain people with dementia.

Commonly used drugs in older adults include:

  • Depakote (valproic acid) – in short- or long-acting formulas

Typical effects

  • Varies depending on the dose and the individual
  • Can be sedating

Risks:

Valproic acid requires monitoring of blood levels. Even when the blood level is considered within acceptable range, side-effects in older adults are common and include:

  • Confusion or worsened thinking
  • Dizziness
  • Difficulty walking or balancing
  • Tremor and development of other Parkinsons-like symptoms
  • Gastrointestinal symptoms including nausea, vomiting, and/or diarrhea

 

4. Antidepressants
Many antidepressants have anti-anxiety benefits, but they take weeks or months to reach their full effect.

And, most clinical studies have found that antidepressants aren’t effective for reducing agitation in dementia.

Commonly used drugs in older adults include:

  • Selective serotonin reuptake inhibitor (SSRI) antidepressants like Celexa (citalopram), Lexapro (escitalopram), Zoloft (sertraline)
  • Paxil (paroxetine) is an often-used SSRI, but it’s more anticholinergic (worsens dementia symptoms) so it’s best to avoid using it with a person with dementia
  • Remeron (mirtazapine) – can increase appetite and sometimes increases sleepiness when given at bedtime
  • Desyrel (trazodone) – a weak antidepressant that is sedating and often used at bedtime to help improve sleep

The antidepressants above are generally well-tolerated by older adults (less risk of side effects), especially when started at low doses and with slow increases as needed.

Typical effects:

  • Varying effect on agitation – usually takes weeks or longer to see an effect.
  • For some, a sedating antidepressant at bedtime can improve sleep (which may reduce daytime irritability)

Risks and side-effects include:

  • Nausea and gastrointestinal distress, especially when first starting or increasing doses
  • Potentially worse agitation or insomnia
  • Increased risk of falls, especially with the more sedating antidepressants
  • Citalopram (in doses higher than 20mg/day) can increase the risk of sudden cardiac arrest due to arrhythmia

 

5. FDA-approved Alzheimer’s medications
Currently, there are 5 FDA-approved drugs that may help delay, lessen, or stabilize Alzheimer’s symptoms like memory loss and confusion.

They can improve quality of life both for the person with Alzheimer’s and for the people caring for them.

These drugs are specifically approved for Alzheimer’s, but some doctors use them to treat symptoms of other dementias as well.

5 FDA-approved Alzheimer’s medications:

  • Aricept (donepezil) is approved for all stages of Alzheimer’s
  • Exelon (rivastigmine) is approved for mild to moderate Alzheimer’s
  • Razadyne (galantamine) is approved for mild to moderate Alzheimer’s
  • Namenda (memantine) is approved for moderate to severe Alzheimer’s
  • Namzaric (a combination of Namenda and Aricept)

In our full article about these 5 FDA-approved medications, we explain what these drugs can and can’t do, scams to watch out for, which drugs are used in which stages of the disease, and when medication should be stopped.

 

Next Step  See Dr. Kernisan’s full article about medications for Alzheimer’s behavior at Better Health While Aging

 

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By DailyCaring Editorial Team
Image: Around Wellington

 

This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money.


4 Comments

  • Reply February 23, 2019

    Karen

    Please reconsider using Antipsychotics for loved ones with dementia/alzheimers. Both of my parents had the disease and were living in a home, as they could no longer handle living alone. At the homes persuasion, they were both put on haldo first, then seroquel. The side effect warnings are real and should be thoughtfully considered. They are real, and deadly. The drugs turned my dad into a zombi, while it just made my mother very agitated and angry, so they just kept upping the dosage. People need to understand, these drugs are primarily being used to make the caregivers job easier, not for the benefit of the patient (I’m aware many will disagree, but one should always do your own research on these things. My research was seeing what happened to my parents, and witnessing how the other patients behaved, which were also very zombie like). My parents went to this home with very, very healthy bodies, but they were both dead within 4 months. My father suffered a stroke, undoubtedly caused by the seroquel use, and my mother fell the day after my father passed away. She was dizzy, hallucinating and had blurred vision. The home, and hospice workers, blamed it on the dementia. It wasn’t. It was the over dosing of seroquel in order to “control” her. They suspected she’d broken her hip and put her into a morphine coma “to keep her from rehurting herself”. What they did was euthanize her. She died 9 days later. Seroquel was the initial cause of both of their deaths, but it was not mentioned on the death certificates. I would warn that there are undoubtedly a lot of deaths caused by these drugs that are never blamed for the death, but rather, dementia is blamed.. If you want to keep your loved one safe, find a natural alternative, music therapy, or one of the many other alternatives out there. We need to treat our seniors with dementia better! This was a life changing, heart breaking lesson I had to learn. I hope this warning will help others to do their research and not always trust the “professionals” who will tell you the use of these drugs are for the patients benefit.

  • Reply December 23, 2017

    Lisa todd

    Our mom is scratching and picking constantly….. 24 7 if she is awake she is at it. Put on mild sedative no help she has holes in her face scratch hide off of hands arms. We are constantly telling her not to have her wear gloves squishy things for hands got the cat with things to keep her busy. Help
    Is that normal.

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