How to treat agitation in dementia

how to treat agitation in dementia

Treatments For Dementia

In this week, double-blind, fixed-dose study, elderly institutionalized patients with dementia and agitation were randomized () to quetiapine mg/day, mg/day, or placebo. The primary endpoint was change in Positive and Negative Syndrome . The drugs they prescribe will depend on your loved ones symptoms. But common ones that can ease agitation include: Medicines that treat paranoia and confusion, called neuroleptics or.

Doctors, nurses and pharmacists who are looking after patients with Parkinson's Disease PD who have been admitted to hospital and are unable to take their what should be included in a thesis statement orally.

In patients unable to take their usual PD medications orally, this tool is designed to convert a patient's usual PD medications to a 'Levodopa equivalent dose' LED. The LED can then be used to calculate what dose of dispersible madopar should be given via a nasogastric tube to provide a patient with their usual amount of PD medication.

The tool also provides a conversion to a rotigotine patch dose. A correction factor is applied to avoid large patch doses that may precipitate side effects such as confusion, hallucinations or delirium.

The following medications can be safely omitted if swallow is compromised: entacapone, selegiline, rasagiline and amantadine. If the patient is on an Apomorphine infusion or uses Duodopa via PEJthen they do not need to be converted to a rotigotine patch instead, please continue to use their existing non-oral treatment.

This tool is no substitute for clinical reasoning nor should it be used as a substitute for expert advice. Extensive effort has been made to ensure this tool is as accurate as possible, however the accuracy and completeness of the information provided can not be guaranteed. The tool should therefore be used as a guide, with no medical decision being solely made on the results provided by this tool. Accept disclaimer and continue to the dosage calculator.

10 Strategies to Calm Agitation from Dementia

A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy an . The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia Edited by: American Psychiatric Association. Jan 22, Research has shown that people with dementia remember feelings and emotions. They can feel love and happiness long after they have forgotten an actual visit or experience. 10 Strategies to Calm Agitation from Dementia. Love in your relationship remains and can be your secret defense against agitation and aggression.

They include problems like:. Because these behaviors are difficult and stressful for caregivers and often for the person with dementia people often ask if any medications can help. In many cases, antipsychotics and other tranquilizing medications can certainly calm the behaviors.

But they can have significant side-effects and risks, which are often not explained to families. Worst of all, they are often prescribed prematurely, or in excessive doses, without caregivers and doctors first putting in some time to figure out what is triggering the behavior, and what non-drug approaches might help.

You may now be wondering what should be the first choice. This depends on the situation, but generally, the first choice to treat difficult behaviors is NOT medication. A possible exception: geriatricians do often consider medication to treat pain or constipation , as these are common triggers for difficult behavior. Instead, medications should be used after non-drug management approaches have been tried, or at least in combination with non-drug approaches.

Of course in certain situations, medication should be considered. These are medications originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms. Commonly used drugs: Antipsychotics often used in older adults include:. Usual effects: Most antipsychotics are sedating, and will calm agitation or aggression through these sedating effects.

Risks of use: The risks of antipsychotics are related to how high the dose is, and include:. Evidence of clinical efficacy : Clinical trials often find a small improvement in symptoms. However, this is offset by frequent side-effects. Studies have also repeatedly found that using antipsychotics in older people with dementia is associated with a higher risk of stroke and of death.

This is a category of medication that relaxes people fairly quickly. So these drugs are used for anxiety, for panic attacks, for sedation, and to treat insomnia.

They can easily become habit-forming. Commonly used drugs: In older adults these include:. Usual effects: In the brain, benzodiazepines act similarly to alcohol, and they usually cause relaxation and sedation. Benzodiazepines vary in how long they last in the body: alprazolam is considered short-acting whereas diazepam is very long-acting. Risks of use: A major risk of these medications is that in people of all ages, they can easily cause both physical and psychological dependence.

Additional risks that get worse in older adults include:. In older adults who take benzodiazepines regularly, there is also a risk of worsening dementia symptoms when the drug is reduced or tapered entirely off.

This is because people can experience increased anxiety plus discomfort due to physical withdrawal, and this often worsens their thinking and behavior.

Stopping benzodiazepines suddenly can provoke life-threatening withdrawal symptoms, so medical supervision is mandatory when reducing this type of medication.

It is also not clear that they work better than antipsychotics, for longer-term management of behavior problems. These include medications otherwise used for seizures. Commonly used drugs: Valproic acid brand name Depakote is the most commonly used medication of this type, in older adults with dementia.

It is available in short- and long-acting formulations. Usual effects: The effect varies depending on the dose and the individual. It can be sedating. Risks of use: Valproic acid requires periodic monitoring of blood levels. Even when the blood level is considered within acceptable range, side-effects in older adults are common and include:.

Many of these have anti-anxiety benefits. However, they take weeks or even months to reach their full effect on depression or anxiety symptoms. Commonly used drugs: Antidepressants often used in older people with dementia include:. Usual effects: The effects of these medications on agitation is variable. SSRIs may help some individuals, but it usually takes weeks or longer to see an effect.

For some people, a sedating antidepressant at bedtime can improve sleep and this may reduce daytime irritability. Risks and side-effects include:. Otherwise, clinical studies suggest that antidepressants are not very effective for reducing agitation. Dementia drugs. In some patients they seem to help with certain neuropsychiatric symptoms.

Note: I am not including medications to manage dementia-related sleep disturbances in this post. You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors. For people with dementia living at home, family caregivers or paid helpers often have limited time and energy to learn and practice behavior management techniques.

Despite the risks of antipsychotics, family members are often anxious to get some relief as soon as possible.

If your relative with dementia is not yet taking medications for behaviors, consider these tips:. If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues. One is whether the behavior issues currently seem manageable or not. So it may also be reasonable to consider a change in medication. The best is to work closely with a doctor AND a dementia behavior expert; some social workers and geriatric care managers are very good with dementia behaviors.

The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing. The main side-effects I see people with dementia experience are excess drowsiness, excess confusion, and falls. Addressing any other anticholinergic or brain-dampening medications can also help. Now should you aim to get your relative completely off antipsychotics, in order to reduce mortality risk, improve alertness and thinking, and to reduce fall risk?

I have found that sometimes tapering people completely off antipsychotics is possible, but it can be a labor-intensive process. In other words, attempting to completely stop antipsychotic medications involves effort, may be followed by worse behavior, and is less likely to succeed if you cannot concurrently provide an increase in beneficial social contact or exercise. It is certainly worth considering, but in people who are taking more than the starter dose of antipsychotic, it can be challenging.

As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them. If your family is struggling with behavior problems, I know that reading this article will not quickly solve them.

But I hope this information will enable you to make more informed decisions. And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. Excellent article, Dr. Thank you for sharing your wisdom on medications used to treat behavioural challenges in dementia. I like how you emphasize medications should not be the first line of defense.

I see medications being prescribed too quickly, especially in nursing homes. They have their place, but only as a last resort. Assessing for delirium and depression are also important factors. Thanks again. Glad you found this useful. Yes, nursing homes can be challenging because the staff are often overworked.

Providing non-drug dementia care requires investment in training staff and supporting them. Thank you for a few suggestions especially on Paxil.

Never thought much of that drug except in PTSD. So Brava to you for your insights. Glad you found this helpful. Yes, in the US, Paxil is unpopular with geriatricians, we feel that citalopram and sertraline have more favorable side-effect profiles in vulnerable older adults.

Of course as you know, the ideal is to treat problems without medication whenever possible, but such non-drug methods often require time, effort, and some training of family and long-term care providers. My father was on the majority of these medications.

My mother had called three times because of his anger and violence. We were fortunate that a psychologist, dealing in geriatric patients only, saw him the jjthird time. He was a godsend. It took about a year to find the right medications and strength to stabilize him. We had no idea he had dementia. About a year prior he had a severe backwards fall on the stairs leading to the front door. He landed head first against the front door. He was put in a coma for 2 weeks afterwards.

We assumed his violent behaviour was due to brain damage from the fall. Also, my dad had always been an angry, agitated and violent person. His anxiety and depression had gone untreated for years. Prior to his dementia he had calmed down quite a bit.

Anyways, yes, the drugs had a dramatic effect on his personality. He became someone I no longer recognized. And over the 10 years he suffered with dementia my mother worked with his doctor, increasing and decreasing the mg on these medications when she felt something was wrong. Thanks for sharing your story.


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