What Medication Is Given For Dementia

What Is Distress And What Adds To It

Every person with dementia is unique. They will react in their own way to events or factors around them.1 People with dementia can become upset and distressed. This may be a result of medical, physical, emotional or environmental factors.2 These expressions often stem from an unmet need.

It is important to know why people with dementia become distressed and find ways to help or prevent it.3

Health professionals refer to expressions of distress as ‘expressions of unmet need or changed behaviours.

Tips For Taking Medicines For Dementia

The person with dementia may need support to manage their medications. You may find it helpful to do the following:

• Develop a routine for giving the medication: ask the pharmacist if medications should be taken at a certain time of day or with our without food. Then create a daily ritual. This might involve taking medications with breakfast or right before bed.
• Pill boxes or blister packs: ask your pharmacist about aids to help you to give medication as prescribed, eg, using pill boxes or blister packs. Read more about remembering to take your medicine.
• Swallowing difficulties: if swallowing is a problem, talk to your pharmacist or doctor. Read more about difficulty swallowing medicines.
• Side effects: ask your doctor or pharmacist about what side effects might occur with the medication and what you should do if you get them. Some dementia medicines may make the symptoms worse, so it’s important to be aware of this and let your doctor know. Read more about medicines and side effects.
• Get the treatment reviewed regularly: a medicine which is useful may not continue to be effective indefinitely because of the progressive changes to the brain caused by dementia.
• Keep a record of all medications, including over-the-counter medicines such as pain relievers, cold medicines and antacids. Also include creams or eye ointments, vitamins, herbal supplements and complementary medicines. Take this record to medical appointments.

Questions To Ask The Doctor

If your loved one’s doctor prescribes a new medication, you could ask:

• What is its name? Does it go by any other names?
• Why have you prescribed this?
• Do they have to take this medication? Are there any alternatives?
• How often and at what time of day should they take it?
• Should they take it with food or on an empty stomach?
• Are there any side effects that I should watch for?
• How much does it cost? Are there less costly or free alternatives?

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Do Dementia Medications Work For Vascular Dementia

Cholinesterase inhibitors, also known as AChE inhibitors, are drugs that are used to help with the symptoms of Alzheimers disease.These medications have been tried in vascular dementia, but they do not work as well as they do in Alzheimers disease. They also have side effects. Sometimes doctors will try using these medications in vascular dementia, especially if they think a patient has a mix of vascular and Alzheimers disease.

Memantine is a dementia drug that is only recommended for people with Alzheimers.

Drugs For Treating Anxiety

Anxiety states, accompanied by panic attacks and fearfulness may lead to demands for constant company and reassurance.

Short-lived periods of anxiety, for example in response to a stressful event, may be helped by a group of drugs known as benzodiazepines. Continuous treatment in excess of two to four weeks is not advisable because dependency can occur, making it difficult to stop the medication without withdrawal symptoms.

In addition, benzodiazepines are associated with a range of side-effects that make them particularly problematic for older people and should not be recommended other than for very short term use. Where an individual has used benzodiazepine drugs for a long period prior to the development of dementia withdrawal may be difficult, but the decision about whether to continue their use or to slowly reduce the dose should be addressed with the doctor treating the person with dementia.

Side-effects

There are many different benzodiazepines, some with a short duration of action, such as lorazepam and oxazepam, and some with longer action, such as chlordiazepoxide and diazepam. All of these drugs may cause excessive sedation, unsteadiness and a tendency to fall, and they may accentuate any confusion and memory deficits that are already present. The long term use of benzodiazepines for neuropsychiatric symptoms is not recommended, but they have a limited role in the short term treatment of agitation in people with dementia .

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Treatment For Mild To Moderate Alzheimers

Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.

Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.

Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.

Avoid Drugs Unless They Are Really Necessary

Before any of the drugs mentioned on this page are prescribed it is essential to ensure that the person with dementia is physically healthy, comfortable and well cared for.

Whenever possible, the person should be helped to lead an active life, with interesting and stimulating daily activities. Behavioural and psychological symptoms of dementia can often result from unreported pain, other illnesses, drug interactions and environmental factors.

It is important to address these factors in the first instance before resorting to medication. By minimising distress and agitation it is usually possible to avoid the use of drugs altogether. If, after trying non-drug treatments, drugs are considered to be necessary remember:

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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
• 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.

Medications For The Treatment Of Alzheimers Disease

There are two types of medications: acetylcholinesterase inhibitors and NMDA receptor antagonists. The two types work in different ways.

Below we provide details of both types of dementia medication, how they are administered, as well as who may benefit from them, and any side effects to look out for.

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Practical Tips On Medications To Manage Difficult Behaviors In Dementia

You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors.

Here are the key points that I usually share with families:

• Before resorting to medication: its essential to try to identify what is triggering/worsening the behavior, and its important to try non-drug approaches, including exercise.
• Be sure to consider treating possible pain or constipation, as these are easily overlooked in people with dementia. Geriatricians often try scheduling acetaminophen 2-3 times daily, since people with dementia may not be able to articulate their pain. We also titrate laxatives to aim for a soft bowel movement every 1-2 days.

• No type of medication has been clinically shown to improve behavior for most people with dementia. If you try medication for this purpose, you should be prepared to do some trial-and-error, and its essential to carefully monitor how well the medication is working and what side-effects may be happening.

• Antipsychotics and benzodiazepines work fairly quickly, but most of the time they are working through sedation and chemical restraint. They tend to cloud thinking further. It is important to use the lowest possible dose of these medications.

• Antidepressants take a while to work, but are generally well-tolerated. Geriatricians often try escitalopram or citalopram in people with dementia.

Use Of Antipsychotic Drugs In People With Dementia

There has been considerable publicity about the excessive use of antipsychotic drugs for the management of behavioural symptoms in dementia. This was highlighted in the recent Department of Health report19 which estimated that at least 180,000 people with dementia are being prescribed antipsychotics each year. There have been a number of regulatory warnings about the risks of such therapy in people with dementia. It is estimated that there are an extra 1,800 deaths a year in the UK because of antipsychotic drug use, together with an additional 1,620 cerebrovascular adverse events .

Risperidone is the only drug specifically licensed for use in dementia, and only for short-term treatment of persistent aggression in moderate to severe AD unresponsive to non-pharmacological approaches and when there is risk of harm to the patient or others.

DLB patients may show severe sensitivity to neuroleptic drugs such as the atypical antipsychotics and fatal reactions have occurred.20 Visual hallucinations are a common, sometimes early, feature of DLB. It is therefore important that physicians are aware of the need to avoid neuroleptic drugs in these patients.

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Who Cannot Take Medicines For Dementia

In general, most people are able to take these medicines. Caution may be needed in people with certain medical problems. For example, people with severe liver or kidney problems may not be able to take them, or they may need a lower dose. Care also needs to be taken in people who have had fits in the past.

The Top Five Dementia Medications For Seniors

• Finding Memory Care Near You

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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What Kinds Of Questions Should You Ask Your Doctor About Any Drug Being 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 dosage be reduced or 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?

Strategies To Address Distress

The underlying cause leading to distress should be identified and addressed by families, friends or carers using a positive approach. People with dementia may use hand gestures, body language, facial expressions, eye contact and actions in their attempts to help their family members, friends or carers identify the reasons for their distress. Below is a checklist of ways to help prevent distress.4

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Medicines To Manage Distress Symptoms

You can manage emotional stress by addressing your mood or distress symptoms. Simple strategies and changes in the delivery of care is recommended.1 If you need medical treatment, your doctor will tailor treatment to your needs. For instance, they may prescribe antidepressants for moderate to severe depression.2

Your health professional should review your medicines often. When this happens depends on the medicine you are taking. Talk to the doctor or other health professional about adding medicine reviews into a care plan. Using a medicines list can help you manage your medicines. Talk to the doctor or other health professionals. They can tell you about the active ingredient and brand names of the medicines you are taking.

You can read about groups of medicines that may help reduce the symptoms of distress below.1,3,4

Anticholinesterases

Some of the symptoms of Alzheimer’s disease are thought to result from a lack of acetylcholine. This is a chemical that sends signals in the brain. These medicines help increase the amount of this chemical in the brain. This can help with the symptoms of Alzheimer’s disease.

Support And Care Is The Most Important Part Of Treatment

When someone is diagnosed with dementia, a full assessment may be suggested to look at their practical skills, their ability to look after themself, their safety in their home, etc. This usually involves assessment by a number of different healthcare professionals. An individual care plan may be drawn up that outlines the person’s specific needs. The aim is to maintain the independence of someone with dementia as much as possible and for as long as possible.

Most people with dementia are cared for in the community. Often, the main carer is a family member. It is important that carers get the full support and advice which is locally available. Support and advice may be needed from one or more of the following healthcare and allied professionals, depending on the severity of the dementia and the individual circumstances:

The level of care and support needed often changes over time. For example, some people with mild dementia can cope well in their own home which is very familiar to them. Some may live with a family member who does most of the caring. If things become worse, a place in a residential or nursing home may be best. The situation can be reviewed from time to time to make sure the appropriate levels of care and support are provided.

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Cholinesterase Inhibitors And Other Drugs

The new generation of cholinesterase inhibitor drugs were originally developed to improve memory and the ability to carry out day-to-day living activities in people with Alzheimers disease.

Evidence suggests that these drugs also have slight beneficial effects on behavioural symptoms, particularly apathy , mood and confidence, delusions and hallucinations. Taking cholinesterase inhibitor drugs may therefore reduce the need for other forms of medication. However, in higher doses these cholinesterase inhibitor drugs may occasionally increase agitation and produce insomnia with nightmares.

Memantine is the most recent antidementia drug to be developed. It works in a different way to the anticholinesterase drugs and is the first drug approved for those in the middle to later stages of Alzheimers disease.

There is some evidence that memantine has a positive effect on mood, behaviour and agitation.

Other Medicines For Alzheimer’s Disease

Memantine

Memantine works by blocking a certain type of receptor called NMDA receptors in the brain. They are involved in sending nerve signals in the brain, eg, in learning and memory. Memantine protects these receptors from a chemical called glutamate, which might be adding to brain degeneration.

Antipsychotics

Antipsychotics work by changing the effect of certain chemicals in the brain. These include dopamine, serotonin, noradrenaline and acetylcholine. These chemicals can impact how you behave, your mood and how you feel. There are many different antipsychotics. They are split into two types the newer or atypical antipsychotics, and the older typical antipsychotics.

Antidepressants

Antidepressants are thought to work by raising certain chemicals in the brain. These include serotonin and noradrenaline. They are linked to your mood and how you feel.

Anxiolytics

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