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.
Hallucinations Delusions And Paranoia Symptoms In Dementia
Hallucinations are when a senior or any person has an inaccurate perception of events or objects. This phenomenon is sensory in nature and can occur at any time, for various lengths of time. A senior suffering from dementia or Alzheimers disease will often hallucinate. During these episodes, they will smell, hear, feel, taste, and even see things or events that are not actually there. These episodes can be minor such as seeing bugs or animals or as dramatic as seeing and interacting with a person who is not present.
Seniors with dementia who experience delusions are those who hold firm to a false belief or idea. Most often, this is due to misinterpreting what has been said or a situation. Delusions can be both positive experiences and negative experiences for the senior. For example, one experiencing a positive delusion may have an idea that they are being called upon to assist with something important where the actual activity doesnt exist.
Paranoia is a form of delusion that is always negative. Many seniors with dementia that suffer from paranoia imagine that those around them are stealing, harming them, or plotting their demise. It is important to remember that suspicious paranoia is a common side effect of the dementia disorder, but there may be times where their feelings are based on actual experiences.
Adverse Events Associated With Antipsychotic Use In Patients With Dementia
Following the FDA analysis, an independent, individual studybased meta-analysis of 15 placebo-controlled atypical antipsychotics clinical trials was conducted by Schneider et al to assess the evidence for efficacy and adverse events associated with the use of atypical antipsychotics in patients with dementia and hallucinations, delusions, aggression, or agitation.31 Trials were included in the study if they met 3 criteria: 1) The study was parallel group, double-blinded, placebo-controlled with random assignment to an orally administered atypical antipsychotic or placebo 2) the patients enrolled had Alzheimers disease, vascular dementia, mixed dementia, or a primary dementia and 3) the patients were randomized and at least 1 outcome measure or adverse event was obtainable.31 These criteria resulted in the inclusion of 3353 patients randomized to drug and 1757 randomized to placebo.31
This analysis revealed that the use of atypical antipsychotics in patients with dementia was significantly associated with adverse events, including somnolence , EPS , abnormal gait , edema , urinary tract infections , and cerebrovascular adverse events .31 Lastly, this analysis of the odds ratio associated with deaths was consistent with the FDA analysis.30,31
|Table. Adverse events associated with atypical antipsychotic use in patients with dementia: a meta-analysis of 15 placebo-controlled clinical trials.31
Association between antipsychotic use and metabolic changes
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Drug Helped Dementia Patients Curb Their Hallucinations And Delusions
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A drug that curbs delusions in Parkinsons patients did the same for people with Alzheimers disease and other forms of dementia in a clinical trial that was stopped early because the benefit seemed clear.
If regulators agree, the drug could become the first offered specifically for treating dementia-related psychosis. It would also be the first new medicine for Alzheimers in nearly two decades.
The daily pill targets some of the most troubling symptoms that patients and caregivers face hallucinations that often lead to anxiety, aggression, and physical and verbal abuse.
Trial results were disclosed this week at an Alzheimers conference in San Diego.
This would be a very important advance, said one independent expert, Dr. Howard Fillit, chief science officer of the Alzheimers Drug Discovery Foundation.
Although the field is focused on finding a cure for dementia and preventing future cases, there is a huge unmet need for better treatment for those who have it now, said , chief science officer for the Alzheimers Assn.
The drug, pimavanserin, is sold as Nuplazid by Acadia Pharmaceuticals Inc. It was approved for Parkinsons-related psychosis in 2016 and is thought to work by blocking a brain chemical that seems to spur delusions.
About 8 million Americans have dementia, and studies suggest that up to 30% of them develop psychosis.
Current anti-psychotic medicines have some major drawbacks and are not approved for dementia patients.
How Does A Person Experience Hallucinations
Some people with dementia will have hallucinations in different senses for example:
- auditory hallucinations hearing things that arent there, like voices or footsteps
- olfactory hallucinations smelling things that arent there, such as smoke or perfume
- tactile hallucinations physically feeling things that arent there, such as being kissed or insects crawling over their skin
- gustatory hallucinations tasting things that arent there, such as a metallic taste in their mouth.
Visual hallucinations are more common in people with dementia with Lewy bodies, and often take the form of complex, vivid and very realistic hallucinations of people or animals. They often last for several minutes and happen often.
Hallucinations can be extremely distressing, and can lead to the person with dementia becoming frightened and in need of support. However, some people find the hallucinations pleasant or comforting. It often depends on what they are hallucinating and how others respond.
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No Easy Solutions But Improvement Is Usually Possible
As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them.
Many probably too many older adults with Alzheimers and other dementias are being medicated for their behavior problems.
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. This way youll help ensure that any medications are used thoughtfully, in the lowest doses necessary, and in combination with non-drug dementia behavior management approaches.
To learn about non-drug management approaches, I recommend this article: 7 Steps to Managing Difficult Dementia Behaviors
And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. For people with Alzheimers and other dementias, its best to be cared for by people who dont turn first to chemical restraints such as antipsychotics and benzodiazepines.
This article was first published in 2016, and was last updated by Dr. K in May 2022.
Different Types Of Antipsychotic Medication
Antipsychotic medication was developed to be prescribed to people of working age experiencing a psychotic condition like schizophrenia. These drugs werent developed to be prescribed to older people or people whose brains are damaged by dementia. Older types of antipsychotics are called typical antipsychotics or major tranquillisers. They include thioridazine, haloperidol and stelazine they are not licensed for the use of people with dementia and are rarely prescribed now.
Newer types of antipsychotics are called atypical antipsychotics. These include risperidone and olanzapine and, since being available from the mid-1990s, increasingly were prescribed for people with dementia. In the late 2000s, this began to change with the publication in 2009 of a major report from the Department of Health into antipsychotics for people with dementia, which questioned their heavy use. Further, in 2011 the Alzheimers Society published best practice guidelines pressing for a much more considered use of antipsychotic medication for people with dementia. Risperidone is now the only drug licensed for very cautious use with people with dementia, and then only in situations involving ongoing aggression for up to six weeks, with the person being very closely monitored for ill-effects.
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Psychotic Symptoms And Dementia
Some people with dementia experience psychotic symptoms, although hallucinations are more likely to be something the person sees rather than hears. It may be thought that someone is experiencing delusions when actually they have misinterpreted what is going around them, for example the person believes that someone has stolen their money because they dont remember where they put it.
Hallucinations and delusions are more common in some types of dementia than others. People who have dementia with Lewy bodies , for example, are quite likely to experience the same visual hallucinations over and over again because of the way this type of dementia affects the brain.
Antipsychotic medication was first prescribed to treat the psychotic symptoms that some people with dementia experience, although they quickly began to be used to treat a wider range of what are sometimes called behavioural and psychological symptoms in dementia . These include aggression, agitation, restlessness, depressed mood, anxiety as well as the more severe difficulties such as hallucinations or delusions.
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Hallucinations happen when someone sees, hears, feels, tastes, or smells something that isnât really there. Someone who hallucinates might see insects crawling on their hand or hear imaginary voices. These are fairly rare with Alzheimerâs disease but are common in other types of dementia, especially Lewy body dementia.
Delusions cause someone to firmly believe in things that are clearly untrue. They might think youâre stealing their things or that there are strangers in the house. These happen in almost half of all people with any type of dementia, including Alzheimerâs disease.
- Hallucinations start to happen with more than one sense. For instance, they feel and hear things as well as see them.
- Hallucinations or delusions cause them to hurt themselves or others.
- They suddenly begin to see sparks, flashes, streaks of light, dark spots, floating spots, or spots that look like a spider web or a large fly. These could be signs of a problem with their eyes.
- They suddenly canât see. This could be caused by a stroke or a problem with their eyes.
- They have severe shortness of breath or chest pain or are vomiting.
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Treatment Of Hallucinations & Delusions
Consulting with your doctor is vital to understand why your loved one is hallucinating or having delusions, and whether medication is necessary. For both delusions and hallucinations, medications called antipsychotics are sometimes prescribed. Antipsychotics, also called neuroleptics, are prescribed for health conditions including schizophrenia, and have been shown to help people with dementia who struggle with these symptoms.
Doctors may prescribe any of a number of antipsychotics after evaluating your loved one. The most commonly used to help dementia-related hallucinations and delusions is Risperidone. It has only been shown to alleviate symptoms in the short term. The side effects of Risperidone are muscle tremors, weight gain, fatigue, and dizziness. Because of this, non-drug treatments are typically preferred. A doctor may, however, conclude that medication is necessary.
The Top Dementia Medications
Sold under the brand name Aricept, this medication is a cholinesterase inhibitor prescribed to help those diagnosed with mild, moderate, and severe Alzheimers disease. Donepezil is taken as a pill, or dissolving tablet for those unable to swallow, with side effects that commonly include gastrointestinal issues and sleep disruption. First approved by the FDA in 1996, this drug was classified to treat all stages of Alzheimers in 2006 after extensive clinical trials showing its potential to delay the onset of memory loss and cognitive abilities.
This medication is sold under the name Razadyne, and it is a cholinesterase inhibitor that is effective and mild to moderate Alzheimers disease. According to the NIH, the main differences between this medication and donepezil are that galantamine users caregivers recorded less burdens during their patients time on the medication, in a 2003 clinical trial. Both medications have similar amounts of side effects, but galantamine users experience a skin rash sometimes, in addition to the standard intestinal issues caused by the tendency of cholinesterase inhibitors to increase stomach acid production.
Taking AChE Inhibitors Long Term
NMDA Receptor Antagonists
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Etiology Of Visual Hallucinations
Visual identification of objects processes from the occipital lobes to the temporal lobes . The object is recognized when this visual information is linked to memories. It is considered that this linking occurs partly in a network called the default mode network . The DMN is activated when a person does not focus on any task in particular . The DMN comprises multiple parts of the brain such as the medial prefrontal cortex, precuneus, posterior cingulate cortex, inferior parietal cortex, and lateral temporal cortex . In contrast, the network activated by attention-demanding tasks is called the task-positive network , which includes the lateral frontal cortex, superior parietal cortex, insula cortex, and frontal operculum cortex . The TPN modulates the DMN, and it is hypothesized that overactivity of the DMN causes VH .
DMN components. DMN is mainly composed of the medial prefrontal cortex, precuneus, posterior cingulate cortex, inferior parietal cortex, and lateral temporal cortex.
Brain network process of linking visual input to memories. DMN properly links visual information input to memories under regulation by TPN . DMN links visual information input to inappropriate memories without adequate regulation by TPN .
Although the pathophysiology of VH is not fully understood, it is reasonable to adjust dopaminergic agents and administer antidementia drugs to treat VH of PDD patients.
A New Drug May Help Reduce Delusions For People With Alzheimers
Dr. Verna R. Porter, MD, neurologist and director of dementia, Alzheimers disease, and neurocognitive disorders at Pacific Neuroscience Institute provides insightful information for those caring for loved ones with dementia and delusions.
Read this Healthline news article about a new drug found to help reduce delusions for people with Alzheimers disease. See the full article below.
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How Can I Help Someone Who Is Experiencing A Hallucination
If youre with someone whos experiencing a hallucination, there are some steps you should take:
- Assess the situation and determine if the hallucination is a problem for the person or you. If the hallucination upsets them or leads them to do something dangerous, react calmly and quickly with reassuring words and a comforting touch.
- Dont argue with the person about what theyre experiencing. If their behavior in response to their hallucination isnt dangerous, you may not need to intervene.
- Avoid trying to reason with the person experiencing a hallucination. You can say you dont see what your loved one is seeing, but some people find it more calming to acknowledge what the person is seeing to minimize stress. For example, if the person sees a dog in the room, it may be more helpful to say, “Ill take the dog out,” rather than arguing that theres no dog.
Administration Options Of Zyprexa
Zyprexa tablets are available as tablets that can be taken once a day, in strengths of 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, and 20 mg, . The medication can be taken with or without meals. No routine blood monitoring is required.
Zyprexa also is available in a formulation that dissolves in the mouth, in 5 mg, 10 mg, 15 mg, and 20 mg strengths, as well as via an intramuscular injection .
Make sure you read the prescription instructions carefully. Ask your pharmacist or doctor about anything that you are not sure of.
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Neurodegenerative Disorders & Their Relationship To Visual Hallucinations
Neurodegenerative disorders are a disparate group of illnesses that share the loss of CNS cells . The clinical presentations reflect the different patterns and disturbances of the pathologies involved ranging from focused loss within specific cerebral nuclei to well-distributed dysfunction involving virtually the entire cerebral cortex. Recent research has highlighted three frequent pathological processes, each associated with a signature disease, but which often co-exist within individual people, with the predominant pathology leading to a characteristic clinical picture .
Thus, disturbances in amyloid metabolism lead to the clinical and pathological picture of Alzheimers disease, including its focal variants of progressive aphasia, progressive apraxia and posterior cortical atrophy abnormal tau metabolism is linked to progressive supranuclear palsy, corticobasal degeneration and variants of frontotemporal dementia, for example, progressive nonfluent aphasia and synuclein dysfunction to a range of disorders including Parkinsons disease and associated Lewy body disorders .
Of these three broad classes, hallucinations are particularly associated with the synucleinopathies.
Can Hallucinations Be Prevented
While not all hallucinations can be prevented, there are some strategies you can use at home that might help reduce the frequency of them for certain people with neurological conditions that may cause hallucinations, including:
- Having good lighting and participating in stimulating activities in the evening.
- Checking for sounds that might be misinterpreted, like noise from a television or an appliance.
- Looking for and correcting lighting that casts shadows, reflections or distortions.
- Covering mirrors with a cloth or removing them if the person thinks theyre looking at a stranger.
If youre taking medication to help treat hallucinations, its important to continue taking the medication unless your healthcare provider tells you otherwise. Stopping the medication suddenly can cause more intense hallucinations.