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Medications For Treating Dementia Symptoms
When the person with Alzheimer's disease exhibits extreme behavior, the
doctor may prescribe certain psychotropic medications to help manage these
symptoms. Drugs may be prescribed for agitation, depression, anxiety,
hostility, delusions, hallucinations and other symptoms. The medications
have the effect of normalizing mood, thought and behavior.
Each individual responds to medication differently. Some people may benefit.
Some may show no change and some may even get worse. Older people generally
have a lower tolerance for these medications than younger persons do.
Brain impairments may keep the drugs from working as intended.
The physician usually begins with a low dosage and increases it slowly.
This is a safer approach for the person with dementia. It allows the physician
to monitor the individual's response to a medication. Lower dosages allow
the body to gradually adjust to the medication.
Generally, medications can produce only moderate changes. Caregivers
must not change the dosage even if the behavior is still occurring. In
fact, more of the medication could create more severe symptoms. Giving
more medicine than prescribed can also create more side effects, which
can be dangerous, especially for the person with dementia. Only the physician
should change dosages.
The caregiver should inform the physician of any other medications, vitamins
and herbal pills the individual may be taking. The caregiver should consult
the physician if side effects develop or if the medication is simply not
working. It also is important for the caregiver to make sure the individual
is receiving the proper dosage at the correct time.
Questions You Should Ask Your Doctor
- What are the benefits of taking the medication?
- How long will the person take the medication before an improvement
will be seen?
- What dosage do you recommend?
- What should the person do if they miss taking a dosage?
- What are the known side effects of the medication?
- Should the person stop taking the medication immediately if a side
- What happens to the person if the drug is stopped suddenly?
- What changes in the person's condition should be reported immediately?
- What other prescription and over the counter drugs might interact
with this medication?
- How might this medication affect other medical conditions?
- How often will the person need to visit the doctor?
- What are the costs of this medication?
Treating Cognitive Symptoms
Alzheimer's disease is most often characterized by loss of memory and
decline in cognitive abilities such as thinking and reasoning. Four drugs
have been approved by the U.S. Food and Drug Administration to treat these
symptoms. Cognex®, Aricept®, Exelon® and Reminyl®. These
medications are used with people in early to middle stages. They do not
reverse the process or cure the disease, but some improvements in memory,
attention, language, and the ability to perform simple tasks may occur.
The use of antipsychotic medication is intended to decrease psychotic
symptoms. These symptoms may include hallucinations, delusions, excessive
suspiciousness and paranoia. Other symptoms, such as agitation and aggression,
are also frequently reduced with these drugs. In general, low doses of
antipsychotics tend to be effective.
The side effects of the antipsychotics are numerous and often the person
with dementia cannot express how they are feeling. Therefore, it is very
important for the caregiver to be aware of the following potential symptoms.
They include: drowsiness, sensitivity to light, weight gain, dry mouth,
shakiness, difficulty urinating, constipation, restlessness, blurred vision,
dizziness, hypotension, stiffness, fast heartbeat, drooling, headache
and shuffling gait.
If the person is routinely taking an antipsychotic, it is recommended
that periodically a dosage reduction be tried by physician order only.
This is to assess if the current amount of medication the person is taking
is still necessary. The person may benefit from reducing the amount of
medication, there by reducing the potential side effects.
The purpose of antianxiety medications is to reduce symptoms of anxiety
and agitation and related insomnia. They may be more appropriate for controlling
anxiety and agitation when the individual is not experiencing more severe
psychotic symptoms, such as hallucinations and delusions.
Side effects can include: over sedation, dizziness, fatigue, drowsiness,
light-headedness, depression, unusual excitement, headache, blurred vision,
nervousness, irritability and breathing problems.
As with other medications, use of antianxiety agents may not be appropriate
if the person has certain other medical conditions. The doctor will take
this into consideration. Withdrawal from this type of medication should
also be supervised by a doctor since there can be problems if the person
has taken the medication for a long time.
People with Alzheimer's disease and other dementia usually lose the ability
to accurately express bodily discomfort or pain. The pain the person experienced
from other medical conditions such as arthritis may be present with Alzheimer's
disease and other dementia. They will also experience other common discomforts
such as headaches, muscle aches, back pain, toothaches and skin conditions,
to name a few.
The caregiver will need to watch for signs of unexpressed pain. These
signs could include but would not be limited to increased pacing, inability
to rest or relax, decreased appetite and increased agitation. Discuss
these signs with the physician and provide pain medication to the person
as ordered. The effectiveness of the medication and potential side effects
will need to be monitored closely.
It is difficult to know how common depression really is in older persons.
It can be masked by other physical problems or the symptoms can be similar
to those of dementia.
The purpose of the antidepressants is to improve the mood, increase energy,
appetite, sleeping habits and social functioning. Some depressions can
be treated successfully and the person's mental status will improve. The
person with dementia cannot always tell you they are feeling "blue"
or why they are sad. The caregiver can be aware of the following depressive
symptoms of sleeping problems, agitation, fatigue, isolation, loss of
appetite, excessive crying, feelings of hopelessness, or a preoccupation
with physical complaints.
There are differences between each of the antidepressant medications
that should be considered in choosing the right treatment. Side effects
may include nausea, vomiting, diarrhea, headache, insomnia, nervousness
and tremor. Some antidepressants may take several weeks to reach a level
where they have an effect.
Difficulty in falling asleep or awakening during the night without being
able to go back to sleep, is frequently a problem for the person with
Alzheimer's disease. There are some medications that can be helpful for
short-term use. Sleeping medications that will take days to be metabolized
by the body or habit forming should be avoided. They will "build
up" in the body and have adverse effects on the person with dementia.
Consult with your physician to obtain the most effective medication. Sleep
aids should only be used for a short time while other non-drug treatments
Experimental Drugs and Treatments
Current research includes tests with experimental drugs and treatments.
However, everyone will not be willing or eligible to become a research
participant. Researchers have specific criteria, such as age, duration
of disease and absence of other illnesses for those they accept into their
studies. For those who do participate, there is the satisfaction of being
involved in the development of a potential treatment for Alzheimer's disease.
Online resources with information about clinical trials includes the
Alzheimer's Disease Clinical Trials Database (www.alzheimers.org/trials).
This site provides information about Alzheimer's clinical trials, explanations
of the Food and Drug Administration approval process and an e-mail announcement
service regarding new trials.
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