What You Can Do About Medications And Difficult Dementia Behaviors
If your relative with dementia is not yet taking medications for behaviors,;consider these tips:
- Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.
- Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors
- Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.
- Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.
- For all medications for dementia behaviors:
- Monitor carefully for evidence of improvement and for signs of side-effects.
- Doses should be increased a little bit at a time.
- Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.
If your relative with dementia is currently taking medications for behaviors,;then you will have to consider;at least the following two issues.
The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.
What You Can Do
When you make the appointment, ask if there’s anything that needs to be done in advance, such as fasting before certain tests. Make a list of:
- Symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
- Key personal information, including any major stresses or recent life changes and family medical history
- All medications, vitamins or supplements you take, including the doses
- Questions to ask the doctor
Even in the early stages of dementia, it’s good to take a family member, friend or caregiver along to help you remember the information you’re given.
For dementia, basic questions to ask the doctor include:
- What is likely causing my symptoms?
- Are there other possible causes for my symptoms?
- What tests are necessary?
- Is the condition likely temporary or chronic?
- What’s the best course of action?
- What alternatives are there to the primary approach being suggested?
- How can dementia and other health issues be managed together?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don’t hesitate to ask other questions.
Risk Factors That Can’t Be Changed
- Age. The risk rises as you age, especially after age 65. However, dementia isn’t a normal part of aging, and dementia can occur in younger people.
- Family history. Having a family history of dementia puts you at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do. There are tests to determine whether you have certain genetic mutations.
- Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer’s disease.
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Care And Support For The Person With The Disease
Here are some suggestions you can try to help yourself cope with the disease:
- Learn about memory loss, dementia and Alzheimer’s disease.
- Write about your feelings in a journal.
- Join a local support group.
- Get individual or family counseling.
- Talk to a member of your spiritual community or another person who can help you with your spiritual needs.
- Stay active and involved, volunteer, exercise, and participate in activities for people with memory loss.
- Spend time with friends and family.
- Participate in an online community of people who are having similar experiences.
- Find new ways to express yourself, such as through painting, singing or writing.
- Delegate help with decision-making to someone you trust.
Advice For Older Adults
Seniors concerned about taking anticholinergic drugs need to approach their primary care physician and talk about the risks versus the benefits of taking these medications, said Shellina Scheiner, an assistant professor and clinical geriatric pharmacist at the University of Minnesota.
Dont try stopping cold turkey or on your own. People can become dependent on these drugs and experience withdrawal side effects such as agitation, dizziness, confusion and jitteriness, Ailabouni said. This can be managed, but you need to work with a medical provider.
Also, dont make the assumption that if drug is available over the counter that its automatically safe for your brain, Boustani said. In general, he advises older adults to ask physicians about how all the medications theyre taking could affect their brain.
Finally, doctors should not give anticholinergic medications to people with any type of dementia, DeKosky said. This will not only interfere with their memory but is likely to make them confused and interfere with their functioning.
Kaiser Health News;is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
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Types Of Medication For Difficult Behaviors In Dementia
Most medications used to treat difficult behaviors fall into one of the following categories:
1.Antipsychotics. These are medications originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms.
Commonly used drugs: Antipsychotics often used in older adults include:
- Risperidone
- Haloperidol
- For a longer list of antipsychotics drugs, see;this NIH page.
Usual effects:;Most antipsychotics are sedating, and will calm agitation or aggression through these sedating effects. Antipsychotics may also reduce true psychosis symptoms, such as delusions, hallucinations, or paranoid beliefs, but its rare for them to completely correct these in people with dementia.
Risks of use:;The risks of antipsychotics are related to how high the dose is, and include:
- Increased risk of falls
- Increased risk of stroke and of death; this has been estimated as an increased absolute risk of 1-4%
- A risk of side-effects known as extrapyramidal symptoms, which include stiffness and tremor similar to Parkinsons disease, as well as a variety of other muscle coordination problems
- People with Lewy-body dementia or a history of Parkinsonism may be especially sensitive to antipsychotic side-effects; in such people, quetiapine is considered the safest choice
2. Benzodiazepines. This is a category of medication that relaxes people fairly quickly. So these drugs are used for anxiety, for panic attacks, for sedation, and to treat insomnia. They can easily become habit-forming.
Treating Dementia And Co
Treatment of dementia and a co-occurring substance use disorder may be necessary for the best therapeutic outcome. Individuals living with dementia sometimes use alcohol and other substances as a form of self-medication for the psychological symptoms of depression and anxiety and other behavior-related problems. On the other hand, substance use disorders may worsen the already existing cognitive deficits in dementia patients.
If you or a loved one are living with a substance abuse disorder, The Recovery Village can help. The Recovery Village specializes in the treatment of addiction along with co-occurring mental health conditions. to learn more about treatment options.
- Sources
Kalapatapu, Raj; et al. Substance use history in behavioral-variant frontotemporal dementia versus primary progressive aphasia. Journal of addictive diseases. January 2016. Accessed June 8, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
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Medications That Block The Effects Of Acetylcholine
Among the best-recognized cognitively dangerous medications are those with anticholinergic properties. This means that the medications block the effect of acetylcholine, an important brain chemical and neurotransmitter that becomes less plentiful in the aging brain. These medications have an impact on brain cells by occupying its receptor molecules, and can help people gain relief from symptoms of insomnia, irritable bowel syndrome, or several other medical conditions. Also, many medications valued for their other effects have incidental anticholinergic properties. Among the clinically significant anticholinergic medications are medications such as tolteridine, often used to treat urinary incontinence. In addition, some antidepressants , antipsychotics, cardiac medications, antispasmodics, antivertigo medications, and antiparkinsonian medications have anticholinergic effects.
Unfortunately, the undesired consequences of anticholinergic medications can be serious. Dry mouth, dry eyes, constipation, or urinary retention may occur. The toxic effects of anticholinergic medications on the brain include confusion, memory disturbance, agitation, and even delirium.
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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Common Otc Drugs Can Cause Dementia
According to the latest statistics for 2019, 14% of Americans aged 71 or older have some form of dementia. Alzheimers disease, which is the most severe and lethal form of dementia, affects an estimated 5.8 million Americans. Of those, 81% are over the age of 75, but approximately 200,000 are younger than 65. In all, 1 in 10 seniors over the age of 65 has Alzheimers dementia.
Due to the high prevalence of dementia and the scarcity of effective conventional treatments, prevention is paramount. Ive written many articles on this topic, highlighting several of the most important prevention strategies, including dietary recommendations and the need for exercise, sun exposure and avoidance of toxins.
One risk factor that has received far less attention is medication side effects, which well focus on here. One class of drugs shown to be of great concern in this regard are anticholinergics drugs that block acetylcholine, a neurotransmitter that performs important functions in your brain and peripheral and central nervous systems.
In your nervous systems, it acts both as an activator and an inhibitor, which is in part why its used in such a wide variety of drugs. For example, acetylcholine triggers muscle contractions and pain responses, and is involved in the regulation of your endocrine system and REM sleep cycle.
Health Conditions With Symptoms Similar To Dementia
These 7 health conditions often cause symptoms similar to dementia in older adults.
Once these conditions are diagnosed and properly treated, the troubling symptoms are usually eliminated.
1. Urinary tract infection Seniors are the most likely group of people to develop a urinary tract infection , something easily treated with antibiotics.
Theyre also the least likely to have typical symptoms like pain during urination, fever, or a frequent urge to go.
Instead, UTI symptoms often show up as a sudden change in behavior. Someone who suddenly cant remember a significant event from last week might have a UTI.
Other signs of an infection include:
- Becoming unusually sleepy or withdrawn
2. Medication side effectsMedications called anticholinergics are commonly used by older adults .
These drugs and their side effects can cause dementia-like symptoms in people without previous cognitive issues.
Thats because anticholinergic drugs block brain chemicals used for learning, memory, and muscle functions.
Older adults already have less of these key brain chemicals because our bodies produce less as we age. And blocking them with drugs makes it even harder for the brain to function properly.
Ask the doctor to do a complete review of all medications and supplements. But DONT start, stop, or change dosage for any medications without first talking with the doctor.
Dementia develops slowly, but delirium starts suddenly.
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If Youre Experiencing Forgetfulness Or Confusion Check Your Medicine Cabinet
by Dr. Armon B. Neel, Jr., February 9, 2016| 0
For a long time doctors dismissed;forgetfulness;and mental confusion as a normal part of aging. But scientists now know that;memory loss;as you get older is by no means inevitable. Indeed, the brain can grow new brain cells and reshape their connections throughout life.Most people are familiar with at least some of the things that can impair memory, including alcohol and drug abuse, heavy cigarette smoking, head injuries, stroke, sleep deprivation, severe stress, vitamin B12 deficiency, and illnesses such as Alzheimer’s disease and depression.
But what many people don’t realize is that many commonly prescribed drugs also can interfere with memory. Here are 10 of the top types of offenders.
What To Do If Your Older Adult Is Taking Anticholinergic Medications
NEVER start, stop, or adjust the dosage for any medications without talking with your older adults doctor.
The first step is to discuss any medication concerns with the doctor as soon as possible. Ask them to explain the risks versus the benefits and to make a recommendation.
Because many seniors have multiple health conditions, they may be taking more than one type of anticholinergic medication.
One anticholinergic drug might not be harmful, but the side effects and doses can add up across different medications.;
Thats why its so important for a doctor to review allthe medications that your older adult takes.
And if different drugs are being prescribed by different doctors, ask their primary physician to review the full medication list, including over-the-counter drugs and supplements.
This could also be a good opportunity for the doctor to safely discontinue drugs that are no longer needed.
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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
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
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.;;;
Could Medications Contribute To Dementia
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
Alzheimers disease and other illnesses that cause dementia are devastating, not only for those affected but also for their friends and family. For most forms of dementia, there is no highly effective treatment. For example, available treatments for Alzheimers disease may slow the deterioration a bit, but they dont reverse the condition. In fact, for most people taking medications for dementia, it may be difficult to know if the treatment is working at all.
Experts predict that dementia will become much more common in the coming years. We badly need a better understanding of the cause of these conditions, as this could lead to better treatments and even preventive measures.
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Drugs That Cause Memory Loss
The thought of memory loss as a result of mediations that are supposed to be aiding your healing is a scary one. Below is a list of drugs with anticholinergic effects;to watch out for when trying to preserve brain health:
1. Incontinence Drugs
Generic drug names:;darifenacin,;oxybutynin,;tolterodine,;flavoxate
Natural options:
2. Muscle Relaxants
Generic drug names:;cyclobenzaprine,;dicyclomine,;orphenadrine
Natural options:
- A 2011 study researched;the effects of massage therapy on muscle pain and relaxation. Researchers found that massage therapy improved bone and muscle pain management in patients, demonstrating the muscle-relaxing effects of massage.
- Magnesium acts as a natural calcium blocker to regulate muscle contractions and help muscles relax.;If youre deficient in magnesium, your muscles may contract too much, causing cramps or spasms.
3. Narcotic Painkillers
Generic drug names:;meperidine
Natural options:
Natural painkillers exist in a number of different forms. Depending on the cause and type of pain youre experiencing, various remedies may be appropriate. Potential natural pain-killing options include:
Generic drug names:;carbamazepine,;oxcarbazepine
Natural options:
5. Parkinsons Medication
Generic drug names:;benztropine,;procyclidine,;trihexyphenidyl,;amantadine
Natural options:
6. Tricyclic Antidepressants
Generic drug names:;amitriptyline,;amoxapine,;clomipramine,;desipramine,;doxepin,;imipramine,;nortriptyline, trimipramine
Natural options:
Support For Caregivers And Care Partners
Providing care for someone with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry, grief, and social isolation are common. If you’re a caregiver or care partner for someone with dementia:
- Learn about the disease and participate in caregiver education programs
- Find out about supportive services in your community, such as respite care or adult care, which can give you a break from caregiving at scheduled times during the week
- Ask friends or other family members for help
- Take care of your physical, emotional and spiritual health
- Ask questions of doctors, social workers and others involved in the care of your loved one
- Join a support group
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