ACT! Alzheimer's Awareness 2010

Behaviors related to dementia

Behaviors related to dementia are challenging to treat. The Alzheimer’s drugs can slow theprogression of the disease in some patients but have limited benefit in controlling behaviors (e.g. pacing, agitation, aggression). Health care providers are divided on treatment methods.

I approach treatment conservatively, first looking at what may be causing the behavior. Is itenvironmental? Is there too much noise, activity, light, caffeine, or sugar intake? Does the patient have aurinary tract infection, constipation, or delirium caused by illness or medications? Is this person depressed or grieving possibly acting out?

Aromatherapy and music can calm dementia patients. Knowing how to approach them is essential: Validation Therapy can be extremely helpful. An example:http://www.ec-online.net/community/Activists/difficultbehaviors.htm.

After environmental, physical, and medical causes have been addressed without effect, then I recommend medication. If patient has history of depression or currently is depressed or anxious, an SSRI
(sertraline, citalopram) is first line. Citalopram (Celexa®) has shown benefit in treating behaviors plus depression and anxiety. These meds can take 6-8 weeks to reach full effect.

Benzodiazepines like Valium®, Ativan®, and Xanax® are not recommended in the elderly due to increased fall risk, confusion and in a small number of patients, worsening of agitation. Seizure meds like
Tegretol® and Depakote® can be beneficial when patient is aggressive or impulsive. However, these meds do require monitoring of blood levels to prevent toxicity. Trazodone, an older antidepressant, hasbeen successfully used for behaviors.

Antipsychotics should be a last choice. Unfortunately it’s a common practice to prescribe them.These drugs do not treat the patient; they sedate them. The exception may be patients showing signs of psychosis or paranoia. Older antipsychotics (e.g. Haldol®, Thorazine®, Mellaril®) can cause abnormal heart rhythm, irreversible movements (tardive dyskinesia), and sudden death. New antipsychotics (e.g. Zyprexa®, Seroquel®, Risperdal®, Abilify®) can also have the same heart rhythm issues, weight gain, diabetes, & increased stroke risk. All have high fall risk.

There’s no question that more research is needed. We’ve only begun to learn about the brainand how our natural body chemicals modulate mood and behavior. Until then, it’s a balancing act: minimize side effects, reduce behaviors, and maintain quality of life.