When Are Medicines For Dementia Usually Prescribed
Your GP will usually refer you to a doctor who specialises in treating dementia, to confirm that you have dementia. The specialist will then decide if you should have treatment. This decision to start treatment and which treatment to start depends on various things. These include what has caused your dementia, what your symptoms are and how severe your dementia is. Dementia is usually classed as being mild, moderate or severe. See also the separate leaflet called Memory Loss and Dementia.
Drugs For Treating Sleep Disturbance
Sleep disturbance, and in particular persistent wakefulness and night-time restlessness, can be distressing for the person with dementia and disturbing for carers. Many of the drugs commonly prescribed for people with dementia can cause excessive sedation during the day, leading to an inability to sleep at night. Increased stimulation and activity during the day can reduce the need for sleep-inducing medications at night. Hypnotics are generally more helpful in getting people off to sleep at bedtime than they are at keeping people asleep throughout the whole of the night. They are usually taken 30 minutes to one hour before going to bed.
Side-effects
If excessive sedation is given at bedtime, the person may be unable to wake to go to the toilet and incontinence may occur, sometimes for the first time. If the person does wake up during the night despite sedation, increased confusion and unsteadiness may occur.
Hypnotics are often best used intermittently, rather than regularly, when the carer and person with dementia feel that a good nights sleep is necessary for either or both of them. The use of such drugs should be regularly reviewed by the doctor.
Calming Medication For Individuals With Dementia
If you are working with a relative or friend with dementia whos using medication to handle their condition, what medication should you expect to come into contact with? What drugs are used to calm dementia patients? Most of the medications used to fall into a few categories:
- Medications that help with pain or constipation
- Antipsychotics
- Medication that helps with seizures
- Anti-depressants
- Medications designed to help with memory and clouded thoughts
Whether youre caring for someone with Alzheimers disease or another dementia diagnosis, medication can help keep individuals calm and reduce their stress and anxiety. Lets take a closer look at the different types of drugs that are used in Alzheimers care and other dementia cases.
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New Research Shows That Nondrug Therapies Are More Effective
According to a new study looking at more than 160 articles, nondrug interventions appeared to be more effective than medications in reducing agitation and aggression in people with dementia. Researchers found that three nonpharmacologic interventions were more effective than usual care: multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy.
For physical aggression, outdoor activities were more efficacious than antipsychotic medications . For verbal aggression, massage and touch therapy were more effective than care as usual. As a result of this study, the authors recommend prioritization of nonpharmacologic interventions over medications, a treatment strategy also recommended by the practice guidelines of the American Psychiatric Association.
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.
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Dementia Medication: Cholinesterase Inhibitors
There are several pharmaceutical options for patients suffering from dementia, including those that seek to improve neurotransmitter functions in the brain. Cholinesterase inhibitors, a family of drugs that attempt to increase the volume and activity of neurotransmitters can help improve memory, thought and judgment in patients in the early to moderate stages of degenerative dementia.
Management Of Cognitive Symptoms
Medicines may be used as an adjunct to non-pharmacological treatment. When medicines are used they should be initiated in consultation with a specialist team experienced in the management of dementia. Treatment should be reassessed on a regular basis and continued only when considered to be having a worthwhile effect on symptoms. Donepezil hydrochloride, galantamine, and rivastigmine are recommended for the treatment of cognitive symptoms of mild-to-moderate dementia due to Alzheimers disease. Memantine hydrochloride is a suitable alternative for patients with moderate-to-severe Alzheimers disease when acetylcholinesterase inhibitors are contraindicated or are not tolerated. A trial of an acetylcholinesterase inhibitor may be considered for managing cognitive symptoms in Lewy body dementia. Pharmacological treatments are not recommended for the treatment of cognitive symptoms in cases of vascular dementia, unless there are elements of mixed dementia which may respond to treatment.Acetylcholinesterase inhibitors can cause unwanted dose-related cholinergic effects . They should be started at a low dose and increased according to tolerability. Choice of agent is generally determined by cost, mode of delivery and risk of adverse effects there is no evidence that one acetylcholinesterase inhibitor is more effective than the others.
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How Should This Medicine Be Used
Donepezil comes as a tablet and an orally disintegrating tablet to take by mouth. It is usually taken once a day with or without food, in the evening just before bedtime. Take donepezil at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take donepezil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Donepezil helps control the symptoms of Alzheimer’s disease but does not cure it. Continue to take donepezil even if you feel well. Do not stop taking donepezil without talking to your doctor.
Your doctor may start you on a low dose of donepezil and increase your dose after 4 to 6 weeks. Your doctor may increase your dose again 3 or more months later.
Swallow the 23-mg tablet whole do not split, crush or chew it. Tell your doctor if you are unable to swallow the tablet whole.
To take the orally disintegrating tablet, place the tablet on your tongue and wait for it to dissolve. Drink some water after the tablet dissolves.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
Reminiscence And Life Story Work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows that they can improve mood and wellbeing. They also help you and those around you to focus on your skills and achievements rather than on your dementia.
You’ll find more details about these treatments in the Alzheimer’s Society’s dementia guide.
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What Are Psychotic Symptoms
People who live with severe mental health problems, such as schizophrenia, experience what are called psychotic symptoms. People with dementia can experience psychotic symptoms too. Hallucinations are an example of a psychotic symptom: they involve seeing, hearing, tasting, smelling or feeling something that isnt actually there. The most common type of hallucination is hearing voices, or what is called an auditory hallucination.
Another type of psychotic symptom is a delusion, which means that a person holds very unusual beliefs about themselves or those around them. A person may believe that they are God or another religious figure for example. More frighteningly, they may believe that someone or something is trying to harm them. This is known as a paranoid delusion.
Drugs For Treating Agitation Aggression And Psychotic Symptoms
Antipsychotics are drugs that were originally developed to treat people with schizophrenia. The use of antipsychotics in people with dementia remains controversial and clinical trials are in progress to better determine their effectiveness.
Side-effects
Side-effects can include excessive sedation, dizziness, unsteadiness and symptoms that resemble those of Parkinsons disease . Some antipsychotics are particularly dangerous for people with dementia with Lewy bodies or Parkinsons disease, being very likely to cause severe stiffness. Some studies have suggested that sudden death may be a rare complication of giving older antipsychotics to people with dementia with Lewy bodies or Parkinsons disease. If such a person must be prescribed an antipsychotic, it should be done with the utmost care, under close supervision, and should be monitored regularly.
A new generation of antipsychotics called atypical antipsychotics may be less prone to produce troublesome side-effects. However, while there is some indication that atypical antipsychotics such as risperidone and olanzapine can be beneficial, it is important to balance the potential benefit against possible side effects, which may include increased risk of stroke and death.
Anticonvulsant drugs, such as sodium valproate and carbamazepine, are sometimes also used to reduce aggression and agitation.
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Treating The Accompanying Symptoms Of Dementia
Dementia often causes a number of behavioural and psychological symptoms which can be very distressing.
These may include depression, anxiety, sleeplessness, hallucinations, ideas of persecution, misidentification of relatives or places, agitation and aggressive behaviour. These symptoms may respond to reassurance, a change in the environment or removal of the source of any distress such as pain. However, sometimes medication may be required for relief.
Major tranquillisers
Major tranquillisers, also known as neuroleptics or anti-psychotics, are used to control agitation, aggression, delusions and hallucinations. Haloperidol is one commonly used drug. In modest doses this drug tends to cause symptoms similar to Parkinsons disease such as stiffness, shuffling gait and shakiness, and older people are very prone to these side effects. Some are unable to tolerate even low doses of Haloperidol.
Newer tranquillisers such as Risperidone have fewer Parkinsons like side effects and have been studied more intensively in people with dementia than Haloperidol has. Risperidone appears to be helpful for the treatment of aggression and psychosis, but may be associated with a slight increase in risk of stroke.
Olanzapine and Quetiapine are sometimes used, but have been less comprehensively studied in the treatment of dementia, and there is some evidence that Olanzapine may also be associated with increased risk of stroke.
Drugs for treating depression
Drugs for treating anxiety
How Is Alzheimer’s Disease Treated
Alzheimers disease is complex, and it is therefore unlikely that any one drug or other intervention will ever successfully treat it in all people living with the disease. Still, in recent years, scientists have made tremendous progress in better understanding Alzheimers and in developing and testing new treatments, including several medications that are in late-stage clinical trials.
Several prescription drugs are already approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. And, on June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.
Most medicines work best for people in the early or middle stages of Alzheimers. However, it is important to understand that none of the medications available at this time will cure Alzheimers.
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What Are The Side
Doctors including geriatricians consider these medications to be well-tolerated. This means that most people dont experience more than mild side-effects, and serious adverse events are rare.
For cholinesterase inhibitors:
- The most common side-effects are gastrointestinal and include nausea, diarrhea, and sometimes vomiting. These affect an estimated 20% of people.
- People tend to adjust to gastrointestinal side-effects with time. It helps to start with a small dose and gradually increase. Rivastigmine is also available in a patch formulation, which tends to cause less stomach upset.
- In the oral formulations, donepezil tends to cause fewer side-effects than rivastigmine and galantamine.
- Some people also experience dizziness, a slowed heart rate, headaches, or sleep changes.
For memantine:
- Dizziness is probably the most common side-effect.
- Some people seem to experience worsened confusion or hallucinations.
- Memantine generally seems to cause fewer side-effects than cholinesterase inhibitors do.
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:
Sleep disturbances
Disinhibited behavior, meaning the person can say or do things that are inappropriate socially speaking
Wandering and pacing
Agitation
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.
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Questions To Ask The Doctor If Drugs Are Prescribed
- What are the potential benefits of taking this drug?
- How long before improvement may be noticed?
- What action should be taken if a dose is missed?
- What are the known side effects?
- If there are side effects, should the drug be stopped?
- If the drug is stopped suddenly, what happens?
- What drugs might interact with the medication?
- How might this drug affect other medical conditions?
- Are there any changes that should be reported immediately?
- How often will a visit to the doctor who prescribed the drug be needed?
- Is the drug available at a subsidised rate?
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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What To Know About Discontinuing Alzheimer’s Drugs
Picture this: You’re the main caregiver for your loved one, and you want to provide the best care possible for them. That includes considering which medications they are receiving and whether these drugs should be continued or discontinued.
Of course, these decisions are made in partnership with a physician, but after the doctor provides the rationale for their recommendations, they will probably ask you for your opinion. So, what to do? First, acknowledge that this can be a stressful decision to make. And second, learn all you can about what research has demonstrated about this decision.
Why Prescribe Antipsychotic Medication For A Person With Dementia
The changes in the brain caused by dementia affect the way a person makes sense of whats going on around them. For example, a person with dementia might not recognise where they are living. Each person with dementia will respond and behave differently in this situation. One person may find it impossible to relax and will walk around, perhaps for a long time, to try to get their bearings. Another person may become frightened and shout angrily because things arent where they expect them to be or they dont recognise the person who is trying to help them have a bath. Somebody else may ask questions about where they are and when theyre going to go home over and over again in an attempt to understand whats happening to them. If the persons behaviour appears to be causing them significant distress, and particularly if there is a risk of the person harming themselves or others, sometimes a doctor will prescribe antipsychotic medication.
It has become clear that people with dementia as a whole are at higher risk of potentially serious adverse effects from antipsychotic medication.
Professor Sube Banerjee, in The use of antipsychotic medication for people with dementia: Time for action
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Stopping Or Continuing Anti
Background
Dementia is the term used to describe a group of illnesses, usually developing in late life, in which there is a deterioration in a persons ability to think, remember, communicate and manage daily activities independently. It can be caused by several different brain diseases, but the most common form is dementia due to Alzheimers disease. At the moment, there are no medical treatments which can prevent dementia or stop it from progressing, but there are two classes of drugs the cholinesterase inhibitors and memantine – which are approved and widely prescribed to treat some of the symptoms. They are used mainly for dementia due to Alzheimer’s disease but also sometimes for other types of dementia. Most of the trials studying the effects of these drugs have been quite short even though dementia usually lasts for years. The drugs can have unwanted side effects in some people. There is uncertainty about their long-term effects and about how useful they are for severe dementia, with different countries making different recommendations. Therefore it can be difficult for doctors and patients to decide if and when these drugs should be stopped once they have been started.
What was the aim of this review?
In this review, we aimed to summarise the best evidence about whether stopping cholinesterase inhibitors or memantine was beneficial or harmful to people with dementia who had been taking them for at least two months.
What we did
What we found
Our conclusions