Sometimes medication is needed to reduce difficult dementia behaviors

Someone with Alzheimer’s disease or dementia may become extremely anxious, paranoid, angry, or even aggressive.

Challenging behaviors like these worsen an older adult’s quality of life and may be too much for families to safely manage at home.

So it’s no surprise that many family caregivers ask if there are medications for Alzheimer’s behavior that can calm their older adult and improve their quality of life (and everyone else’s).

A person’s actions could be caused by boredom, frustration, fear, physical discomfort, or an overstimulating environment.

So before using medication, it’s a good idea to try non-drug techniques to reduce challenging dementia behavior.

But sometimes, even if all those problems are solved, a person’s behavior doesn’t improve and they’re clearly still in distress.

Dr. Leslie Kernisan, a San Francisco Bay Area geriatric doctor, explains the 5 types of medication that are used to treat difficult dementia behavior.

We’ve summarized the key points from her article here: the 5 behavioral medications, how they can reduce challenging behavior, side effects, risks, and warnings.

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5 types of medications for Alzheimer’s behavior

1. Antipsychotics Antipsychotic medications were originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms like hallucinations, delusions, anxiety, and suspiciousness.

Commonly used drugs in older adults include:

1. Risperdal (risperidone)

2. Seroquel (quetiapine)

3. Zyprexa (olanzapine)

4. Haldol (haloperidol)

Typical effects:

1. Sedating

2. Calm agitation or aggression through the sedating effects

3. Reduce symptoms like delusions, hallucinations, or paranoid beliefs (but it’s rare that they’ll be completely solved)

Risks include:

1. Increased risk of stroke and of death

2. Decreased cognitive function

3. Possible acceleration of cognitive decline

4. Increased fall risk

5. Muscle coordination problems, stiffness, and tremor (similar to Parkinson’s disease)

Important: People with Lewy body dementia or a history of Parkinsonism may be especially sensitive to antipsychotic side-effects. For those individuals, Seroquel (quetiapine) is considered the safest choice.

2. Benzodiazepines

These drugs tend to relax people fairly quickly so they’re used for anxiety, panic attacks, sedation, and to treat insomnia.

However, it’s possible for these medications to have an opposite effect and increase agitation. Also, they can easily be habit-forming.

Even if someone might appear sedated, it’s not clear that these meds truly improve agitation and difficult behaviors in most people. It’s also not clear that they work better than antipsychotics for longer-term management of behavior problems.

Commonly used drugs in older adults include:

1. Ativan (lorazepam)

2. Restoril (temazepam)

3. Valium (diazepam)

4. Xanax (alprazolam)

Typical effects:

1. Relaxation

2. Sedation

Risks:

1. Major risk: these drugs can easily cause physical and psychological dependence

2. Increased risk of falls

3. Increased agitation, disinhibition, or restlessness

4. Increased confusion

5. Causing or worsening delirium

6. Faster cognitive decline

7. Worsening dementia symptoms after reducing or tapering off the medication (withdrawal symptoms increase anxiety and discomfort and worsen thinking and behavior)

WARNING: Stopping benzodiazepines suddenly can cause life-threatening withdrawal symptoms. A doctor’s supervision is a MUST when tapering off or stopping this type of medication.

Advertisement 3. Mood-stabilizers These are medications that are typically used for seizures. They reduce the “excitability” of brain cells.

Studies of randomized trials didn’t find this medication to be helpful and found that negative effects were worrisome.

However, some geriatric psychiatrists and other experts feel that it can work well to improve behavior in certain people with dementia.

Commonly used drugs in older adults include:

1. Depakote (valproic acid) – in short- or long-acting formulas

Typical effects

1. Varies depending on the dose and the individual

2. Can be sedating

Risks:

Valproic acid requires monitoring of blood levels. Even when the blood level is considered within acceptable range, side-effects in older adults are common and include:

1. Confusion or worsened thinking

2. Dizziness

3. Difficulty walking or balancing

4. Tremor and development of other Parkinsons-like symptoms

5. Gastrointestinal symptoms including nausea, vomiting, and/or diarrhea

4. Antidepressants Many antidepressants have anti-anxiety benefits, but they take weeks or months to reach their full effect.

And, most clinical studies have found that antidepressants aren’t effective for reducing agitation in dementia.

Commonly used drugs in older adults include:

1. Selective serotonin reuptake inhibitor (SSRI) antidepressants like Celexa (citalopram), Lexapro (escitalopram), Zoloft (sertraline)

2. Paxil (paroxetine) is an often-used SSRI, but it’s more anticholinergic (worsens dementia symptoms) so it’s best to avoid using it with a person with dementia

3. Remeron (mirtazapine) – can increase appetite and sometimes increases sleepiness when given at bedtime

4. Desyrel (trazodone) – a weak antidepressant that is sedating and often used at bedtime to help improve sleep

The antidepressants above are generally well-tolerated by older adults (less risk of side effects), especially when started at low doses and with slow increases as needed.

Typical effects:

1. Varying effect on agitation – usually takes weeks or longer to see an effect.

2. For some, a sedating antidepressant at bedtime can improve sleep (which may reduce daytime irritability)

Risks and side-effects include:

1. Nausea and gastrointestinal distress, especially when first starting or increasing doses

2. Potentially worse agitation or insomnia

3. Increased risk of falls, especially with the more sedating antidepressants

4. Citalopram (in doses higher than 20mg/day) can increase the risk of sudden cardiac arrest due to arrhythmia

5. FDA-approved Alzheimer’s medications Currently, there are 5 FDA-approved drugs that may help delay, lessen, or stabilize Alzheimer’s symptoms like memory loss and confusion.

They can improve quality of life both for the person with Alzheimer’s and for the people caring for them.

These drugs are specifically approved for Alzheimer’s, but some doctors use them to treat symptoms of other dementias as well.

5 FDA-approved Alzheimer’s medications:

1. Aricept (donepezil) is approved for all stages of Alzheimer’s

2. Exelon (rivastigmine) is approved for mild to moderate Alzheimer’s

3. Razadyne (galantamine) is approved for mild to moderate Alzheimer’s

4. Namenda (memantine) is approved for moderate to severe Alzheimer’s

5. Namzaric (a combination of Namenda and Aricept)

In our full article about these 5 FDA-approved medications, we explain what these drugs can and can’t do, scams to watch out for, which drugs are used in which stages of the disease, and when medication should be stopped.

Next Step See Dr. Kernisan’s full article about medications for Alzheimer’s behavior at Better Health While Aging

Recommended for you:

1. Solve Challenging Alzheimer’s Behaviors with Expert Communication Tips

2. Dementia and Anger: 9 Calming Strategies

3. 14 Ways to Handle Screaming and Crying in Dementia

By DailyCaring Editorial Team Image: Around Wellington

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