Sometimes medication is needed to reduce difficult dementia behaviors
Someone with Alzheimer’s disease 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, it’s a good idea to 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, 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.
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.
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.
Recommended for you:
- Solve Challenging Alzheimer’s Behaviors with Expert Communication Tips
- Dementia and Anger: 9 Calming Strategies
- 14 Ways to Handle Screaming and Crying in Dementia
By DailyCaring Editorial Team
Image: Around Wellington
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Evelyn Bernice Stefl
My husband was on risperdone and I took him off it because I think it is not helpful. He is not aggressive or combative and it just sedates him. I stopped taking him to a neurologist as they never really do anything for him -they review his meds with me and that is the sum total of the visit. His primary care doctor can do that. My son is upset with me for taking him off the medicine but I really don’t see any difference in his behaviour except for asking the same thing over and over which I attribute to the dementia not the meds. I can put him back on the risperdone if you think I should.
DailyCaring
It’s essential that you consult with the doctor before stopping or making changes to any medications. Some medications can cause serious health issues if stopped suddenly.
It’s also a good idea to let the doctor know about your concerns about his medications. Perhaps there are some that he no longer needs to be taking. Or, maybe different medications could be more helpful than the ones he’s currently taking.
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.
DailyCaring
I’m so sorry that this happened to your parents 🙁
Antipsychotic medications carry risks, especially for seniors and people with dementia and other serious health conditions. They can be used carefully to help those who don’t respond to non-drug methods, but unfortunately, some care communities do overuse them.
In case anyone is interested, we’ve got an article that specifically covers non-drug methods to reduce challenging dementia behavior — 6 Things to Try Before Using Antipsychotic Medications for Dementia Behaviors https://dailycaring.com/6-things-to-try-before-using-antipsychotic-medications-for-dementia-behaviors/
We also have many more tips on reducing and managing challenging dementia behaviors without medication here — https://dailycaring.com/tag/challenging-dementia-behaviors/
Deborah Buchanan
Since 1987, federal legislation *Obra ’87, protects the nursing home resident against chemical restraints inclusive of both antipsychotics and benzos. Sedation is never consider a humane manner of dealing with belligerent behavior in a patient w/ dementia.
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.
DailyCaring
I’m so sorry this is happening 🙁 Sometimes compulsive scratching happens when a person is feeling anxious and doesn’t know how to express it or how to help themselves. Or, it could be related to dementia hallucinations, delusions, or OCD-like behavior. It sounds like the sedative isn’t working well, so it would be good to let the doctor know so it can either be discontinued or changed to something else. It would also be a good idea to do a full medication review to make sure that drug side effects or interactions aren’t contributing to this behavior. You may also be able to get some clues as to what’s causing this behavior by gently asking open ended questions to encourage her to express thoughts or concerns. Even if what she says might not make sense, it could give you some clues or help her feel validated and heard (if she is anxious about something).
There are a couple of other things that you could try. One is to create a calming environment, keep her on a regular daily schedule, use a weighted blanket/lap pad/vest, or try a variety of sensory and engaging activities. Another option to consider is to let her shred tissues or pop bubble wrap. More information on those suggestions here:
— http://dailycaring.com/reduce-dementia-agitation-with-a-calm-environment-5-helpful-tips/
— http://dailycaring.com/why-routine-is-important-for-seniors/
— http://dailycaring.com/weighted-blankets-in-dementia-care-reduce-anxiety-and-improve-sleep/
— http://dailycaring.com/6-ways-to-help-seniors-with-alzheimers-keep-hands-busy/
— http://dailycaring.com/6-alzheimers-sensory-activities-reduce-anxiety-without-medication/