The major symptoms associated with Alzheimer’s disease and dementia relate to memory loss; most often when we think of someone with dementia we think of forgetfulness and the inability to recognize people and things familiar to that person. But there is a whole other set of symptoms that can burden dementia patients, and even more so their caregivers. Agitation, anxiety, wandering, sleeplessness, and aggression are also common symptoms of these diseases; most patients with dementia have at least one of these symptoms, if not more. Some of the more common dementia medications are antipsychotics, which are prescribed to control these symptoms. But is the answer to these behavioral issues drug treatment, or is there a better, safer solution?
The alarmingly high rate of antipsychotic use in dementia patients
To control such behavioral symptoms like agitation and aggression, many dementia patients are prescribed antipsychotic medications. According to a report recently released by the Government Accountability Office (GAO), one third of dementia patients living in nursing homes are on an antipsychotic medication to control behavioral symptoms. And about one in seven dementia patients who live outside of nursing homes receive this type of drug treatment. What’s even more alarming is the finding that some factors contributing to this high rate of prescription include things unrelated to the patients themselves, including low staffing at a nursing home.
Major risks of using antipsychotics for dementia
The GOA report urges for the need to reduce antipsychotic use in dementia patients. Antipsychotics, which are meant to treat psychiatric disorders such as schizophrenia and bipolar disorder, are not approved by the FDA as dementia medications. So in most cases, antipsychotics are used “off label” with dementia patients, meaning they are administered for an unapproved use. While some specific antipsychotics do show some benefit to dementia patients, their effectiveness can be quite low.
The news gets worse; antipsychotics actually increase the risk of mortality for dementia patients. In 2005 the FDA required all atypical antipsychotics to be labeled with a warning of the higher risk of death related to their use, and this was followed up by a similar warning for conventional antipsychotics in 2008.[2,3] The risk gets worse with prolonged use, as well. Side effects of the drugs include sedation, low blood pressure, movement disorders, and metabolic syndrome, all of which can be dangerous. They can increase the risk of falling as well.
Non-pharmacological treatments are more effective, and far safer
A study published in March of 2015 in the journal BMJ looked at drug treatment and alternative treatments for the behavioral symptoms of dementia. They found that non-pharmacologic treatments can be much more effective than antipsychotic use, and they come with significantly lower risk. Alternative treatment options include various patient-centered therapies such as cognitive training, validation therapy, reminiscence therapy, music therapy, and massage.
The study found that the most effective interventions were those that focused on the caregivers, training them to problem solve to manage behavioral symptoms. Strategies include identifying triggers of problem behaviors, providing activities to keep the person engaged, enhancing communication with the person, and altering the environment to make it less cluttered, for example.
The authors say that drugs have a place in emergency situations when the patient or caregiver is in danger. But they conclude that in most cases, the first choice should always be to avoid drug treatment and try alternative interventions instead. So check your loved one’s prescription list. If antipsychotics are on the list, make sure they are there for good reason, and if possible, see if the medication can be removed.
For a variety of all-natural strategies for fighting memory loss and treating dementia, read our collection of blogs on the topic here.
Share your experience
Do you care for someone with Alzheimer’s or dementia? What are your thoughts on the dangerous use of antipsychotics as dementia medications? Share your experience with behavioral issues related to dementia in the comments section below.