Are Antipsychotic Drugs Justified For Alzheimers / Dementia
Studies have found antipsychotics should be considered as a last resort to temper abusive behavior in someone with Alzheimers or related dementia, but the drugs still have a role in treatment. Antipsychotics have been prescribed to address symptoms including those listed above and also inappropriate social behaviors, oppressive anxiety, and even physical motions that are repetitive and worrisome, like tremors or hand-kneading.
The most commonly prescribed antipsychotics for dementia behavior are aripiprazole , olanzapine , quetiapine and risperidone . The federal Food and Drug Administration has approved all these drugs for the treatment of mental health problems including schizophrenia, bipolar disorder, and severe depression. The FDA, importantly, has not officially approved these drugs for behaviors in patients with dementia. These drugs, the FDA has warned of antipsychotics, are not approved for the treatment of behavioural symptoms in elderly patients with dementia. The reasons for this warning are further explained below.
A last thing to consider is that studies comparing the effects of an antipsychotic to a placebo have found only marginal difference in elderly people with dementia. Only about half of people with dementia who take antipsychotics demonstrate any benefit, and, of those, the benefits may be marginal.
Drugs In Dementia Treatment
- There is currently no cure for dementia however, there are medications that help with dementia symptoms.
- Health Canada has approved 4 drugs to improve cognition in dementia patients: donepezil, rivastigmine, galantamine and memantine. Donepezil, rivastigmine and galantamine are known as cholinesterase inhibitors and are prescribed for mild to moderate dementia. Memantine is one of a group of drugs called NMDA receptor antagonists and is prescribed for moderate to severe dementia.
- These drugs do not cure or slow the progression of the disease. Rather, they improve cognition and function .
- Medications to treat other symptoms or conditions, such as psychosis, depression, sleep disturbances or agitation, may also be prescribed.
- In 20152016, a total of 23,375 seniors living with dementia in Newfoundland and Labrador, Prince Edward Island, Manitoba, Alberta and British Columbia were prescribed the drugs listed above, according to CIHIs National Prescription Drug Utilization Information System. This is about 23.7% of all seniors living with dementia in these provinces, down from 28.0% in 20112012.
Non-pharmacological treatments such as social activity, music and cognitive therapies have also proven to be helpful in managing challenging behaviours and symptoms. These approaches can improve well-being and quality of life for seniors with dementia as well as for their caregivers.
Ways To Reduce The Risk Of Dementia
There is no way to prevent all types of dementia however, having a healthy lifestyle and managing chronic conditions help improve overall health and reduce the risk.
Studies suggest that about a third of dementia cases might be delayed or prevented by addressing potentially modifiable risk factors.
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Alternatives To Pharmaceutical Treatments
There have been many natural remedies to aging-related memory issues throughout history, and European and Eastern countries continue to refer patients experiencing memory loss-related troubles to a variety of holistic treatments, including:
- Huperzia serrata, a moss, is a traditional Chinese medicine. It is now being researched in pharmacology as the drug Huperzine A. Its been shown as both a powerful AChE inhibitor, as well as a protectant against further cellular damage due to various functions of dementia-type diseases. This supplement should not be taken in conjunction with other AChE inhibitors, for risk of serious side effects.
- Dietary changes like increasing the intake of healthy foods such as avocados, blueberries, and the spice turmeric, have been researched and shown to slow the cognitive decline brought about by dementia
- Exercise has been shown to produce a hormone known to battle dementia, named brain-derived-neurotrophic-factor, or BDNF, that greatly improves cognitive ability. Recent studies show that people with higher levels of BDNF have 33% less cognitive defects than those with lower levels of the hormone. See our list of the top 25 exercise videos and equipment for seniors to find tools to help you increase your BDNF levels safely at home, alone or with company.
Who Is The Drug For And What Are The Benefits
The NICE guidance recommends use of Memantine for people with severe Alzheimers disease, and for those with moderate Alzheimers who may suffer significant side effects from cholinesterase inhibitor drugs.
For those in the middle and later stages of the disease it can slow down the progression of symptoms such as disorientation, as well as difficulties with daily activities .
There is some evidence that memantine may also help with symptoms such as aggression and delusion.
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Why The Drugs Affect Your Mind
Both anticholinergics and benzodiazepines affect the activity of neurotransmitterschemical messengers that work in the central nervous systembut the drugs work in slightly different ways.
Anticholinergic drugs block the action of acetylcholine. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates the autonomic nervesthose that regulate contractions of blood vessels, airways, and our cardiovascular and digestive systems. The strongest anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and sleeping pills.
Benzodiazepines boost another neurotransmitter’s effectiveness. They make gamma-aminobutyric acid which slows the activity of neurons in the brain-more potent. For that reason, they are used to calm anxiety and help people sleep.
Antipsychotics Use In Assisted Living And Memory Care
Assisted living and memory care residences have been caught using antipsychotics to manage residents behavior. This practice is called chemical constraints, and has resulted in massive penalties for drug manufacturers. The manufacturers of Zyprexa, for instance, had to pay more than $1.4 billion after settling with the government over accusations they marketed the drug to nursing homes as a treatment for dementia. In 2017, Human Rights Watch released a report titled They Want Docile. It began: In an average week, nursing facilities in the United States administer antipsychotic drugs to over 179,000 people who do not have diagnoses for which the drugs are approved. They determined it was the sedative effect, rather than any medical benefit, motivating the use of antipsychotics. Antipsychotic drugs are used sometimes almost by default, for the convenience of the facility, including to control people who are difficult to manage.
Did You Know?
Even worse: Reports have found residents were often given these drugs without their knowledge. Because a company may have marketed itself as effective for dementia when it isnt, and because the sedative effect makes residents easier to care for, and because side effects like the acceleration of cognitive decline are happening internally and thus not apparent by the patients actions, staff may be unaware of the harm theyre committing.
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Who Can Antipsychotic Drugs Help
Some antipsychotics can have a small but significant beneficial effect on agitation, aggression and, to a lesser extent, psychosis in people with Alzheimers disease. Improvements are normally only seen once these drugs have been taken for several weeks.
Antipsychotic drugs may be prescribed for people with Alzheimers disease, vascular dementia or mixed dementia .
If a person with dementia with Lewy bodies or Parkinsons disease dementia is prescribed an antipsychotic drug, it should be done with the utmost care, under constant supervision and with regular review. This is because people with these types of dementia, who often have visual hallucinations, are at particular risk of severe negative reactions to most antipsychotics.
The doctor is likely to choose a drug with the least side effects, but they will only be able to use very small doses. This is unlikely to have much effect on agitation and psychosis.
These changes are likely to need personalised non-drug approaches.
How Do Alzheimer’s Drugs Work
Acetylcholine is a chemical that helps pass messages between certain brain cells involved in memory. In Alzheimer’s disease, these brain cells start to die and the amount of acetylcholine is very much reduced.
Memory starts to suffer. Cholinesterase Inhibitors reduce the breakdown of acetylcholine and increases its levels in the brain. This reduces some of the symptoms of Alzheimer’s disease.
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Treatment For Moderate To Severe Alzheimers
A medication known as memantine, an N-methyl D-aspartate antagonist, is prescribed to treat moderate to severe Alzheimers disease. This drugs main effect is to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both the person with Alzheimer’s and caregivers.
Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for the treatment of moderate to severe Alzheimers.
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Tip Sheet: Ten Medications Older Adults Should Avoid Or Use With Caution
Because older adults often have long-term health conditions that require treatment with multiple medications, there is a greater chance of experiencing unwanted drug side effects. Older people can also be more sensitive to certain medications.
To help you make better-informed decisions about your medications, and to lower your chances of overmedication and serious drug reactions, the American Geriatrics Societys Health in Aging Foundation recommends that older people be cautious about using the following types of medications, including some that can be purchased without a prescription .
If you are taking any of these medications, talk to your healthcare provider or pharmacist. Do not stop taking any medication without first talking to your healthcare provider.
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Fdas Accelerated Approval Program
Aducanumab was approved through the FDAs Accelerated Approval Program, which provides a path for earlier approval of drugs that treat certain serious conditions. This helps people living with the disease gain earlier access to the treatment. The approval of aducanumab was based on the ability of the drug to reduce amyloid in the brain. When using the accelerated approval pathway, drug companies are required to conduct additional studies to determine whether there is in fact clinical benefit after the drug is approved. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
What Are The Cholinesterase Inhibitor Medications Called
Donepezil: originally patented as the brand name Aricept, but more widely available now as the generic Donepezil
Rivastigmine: originally patented as Exelon, and is now also available as other brands as well as generic Rivastigmine
Galantamine originally patented as Reminyl and is now also available as generic galantamine and the brands Reminyl XL, Acumor XL, Galsya XL and Gatalin XL.
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What Happens To A Persons Brain And Body As Dementia Gets Worse
Unfortunately, many types of dementia are conditions that worsen over time. When your brain doesnt get the nutrients and oxygen it needs, or junk blocks needed communication between the nerve cells of the brain, your brain tissue begins to die.
Alzheimers disease and other types of dementia usually begin with memory loss or lapses in judgment things that can be lived with for a while. As you lose more and more brain function, functions vital to life begin to be affected. Vital functions include breathing, digestion, heart rate and sleep.
In the late stages of dementia, people cant perform the tasks needed to keep their bodies alive. Brain damage and muscle weakness no longer allow even simple, needed movements. You cant communicate, walk, talk, control your bladder or bowels, feed yourself, or chew or swallow food without help.
When you cant care for yourself, move about, eat or drink enough to keep yourself hydrated and nourished, plus have mental decline, you leave yourself vulnerable to other illnesses. Pneumonia is one of these commonly seen illnesses in people with dementia. With a now frail body, a person may not be able to fight infections or even benefit from medication. The persons pain and discomfort may outweigh treatment options that can only offer a short-term benefit.
Anxiety And Insomnia Medications
Benzodiazepines, a class of medications used to treat anxiety or insomnia, comprise another group that has been linked with cognitive difficulties. Although these medications are truly a blessing for some individuals immobilized by anxiety, their use can be accompanied by sedation and mental slowing. A recent study even suggested that prolonged use of benzodiazepines might be a risk factor for later dementia, although experts have questioned the significance of this finding and clinicians continue to prescribe anti-anxiety medications such as lorazepam or sleeping pills such as temazepam and consider them very beneficial when used properly.
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Drugs To Treat The Cognitive Symptoms Of Dementia
A number of drugs are currently available in Australia for use by people with dementia. These drugs fall into two categories, cholinergic treatments and Memantine.
Cholinergic treatments offer some relief from the symptoms of Alzheimers disease for some people for a limited time. Drugs known as acetylcholinesterase inhibitors work by blocking the actions of an enzyme called acetylcholinesterase which destroys an important neurotransmitter for memory called acetylcholine.
Current cholinergic treatments are approved for use for people with mild to moderate Alzheimers disease. A number of the acetylcholinesterase inhibitors are available as subsidised medicines under the Australian Pharmaceutical Benefits Scheme.
People may receive these drugs at nominal cost if a physician or psychiatrist has found them to have a diagnosis of Alzheimers disease.
They must show improvement on a commonly used test of mental function in the first six months of treatment in order to receive further supplies of subsidised medication.
Memantine targets a neurotransmitter called glutamate that is present in high levels when someone has Alzheimers disease. Memantine blocks glutamate and prevents too much calcium moving into the brain cells causing damage. It is the first in a new class of therapies and acts quite differently to the acetylcholinesterase inhibitors that are currently approved for treatment in Australia.
What Medications Are Available To Manage Dementia
Drugs approved for the most common form of dementia, Alzheimers disease, include:
- Cholinesterase inhibitors, including donepezil , rivastigmine and galantamine .
- NMDA receptor antagonist memantine .
- Anti-amyloid antibody aducanumab .
Healthcare providers use these drugs to treat people with some of the other forms of dementia.
Cholinesterase inhibitors and the NMDA receptor antagonist affect different chemical processes in your brain. Both drug classes have been shown to provide some benefit in improving or stabilizing memory function in some people with dementia.
Cholinesterase inhibitors manage the chemicals in your brain that allow messages to be sent between brain cells, which is needed for proper brain function. Memantine works similarly to cholinesterase inhibitors except it works on a different chemical messenger and helps the nerve cells survive longer.
Aducanumab targets amyloid proteins, which build up into the plaques seen in the brains of people with Alzheimers disease.
Although none of these drugs appear to stop the progression of the underlying disease, they may slow it down.
If other medical conditions are causing dementia or co-exist with dementia, healthcare providers prescribe the appropriate drugs used to treat those specific conditions. These other conditions include sleeping problems, depression, hallucinations and agitation.
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Medications That Can Be Used To Handle Anxiety In Elderly With Dementia
One of the most difficult situations to deal with when handling a dementia patient is when they are acting anxious or agitated. These issues go beyond thinking and memory. These issues include things like:
Disinhibited behavior, meaning the person can say or do things that are inappropriate socially speaking
Wandering and pacing
Irrational beliefs, paranoid behaviors, and delusions
These neuropsychiatric symptoms can be hard to deal with and they are one of the most challenging things that caregivers can deal with when caring for dementia patients. There is no specific drug that can be used for the treatment of dementia, but development can be slowed down and symptoms treated.
The Top Five Dementia Medications For Seniors
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Dementia is a common disease seen in older adults, affecting over 50 million people around the world, according to the World Health Organization . But, it is not a normal part of aging. Examples of typical memory loss experienced by people of all ages include occasionally forgetting but later remembering events, names, and phone numbers. When memory loss becomes disruptive to your daily life, it might be time to see your medical team about your cognitive health and discuss possible medications to help combat the symptoms of dementia, as well as check for physical signs of Alzheimers disease and related dementias.
Through careful research, we have created this guide to educate you on Alzheimers disease and related dementias, the top dementia medications as well as less-targeted dementia medications that can be useful in treating symptoms, and alternative options you might want to discuss with you or your loved ones doctor.
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