Dementia: Medicines to Treat Behaviour Changes

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Dementia: Medicines to Treat Behaviour Changes

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The decision to try medicine to treat behaviour problems in Alzheimer's disease is different for each person. The decision weighs the risks and benefits of these medicines. Your doctor can help you decide. Medicines for behaviour problems linked to dementia do not work very well for most people and may have serious risks.

Medicines can be used to treat behaviour problems caused by Alzheimer's disease and other diseases that cause dementia. They should be used only after other non-drug approaches have failed to improve a person's symptoms. Medicine may be needed when the person is in danger of harming himself or herself or others or when the caregiver is unable to deal with the situation using other means.

Antipsychotic medicines

Antipsychotic medicines may help relieve more severe agitation or psychosis (disordered thought processes).

  • Low doses may make the person more comfortable by reducing certain symptoms, such as delusions, suspicion of others (paranoia), hallucinations, hostility, or agitation.
  • These medicines also may improve sleep.
  • The side effects may make some symptoms of Alzheimer's disease worse, such as apathy, withdrawal from family and friends, and inability to think clearly.
  • These are powerful medicines. They commonly cause dizziness, drowsiness, movement disorders that resemble Parkinson's disease, low blood pressure upon standing (orthostatic hypotension), and other side effects.

Examples of medicines sometimes used to treat hallucinations, paranoia, and severe agitation in people with dementia include haloperidol, risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa).

Health Canada and U.S. FDA advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories stating that people with dementia who use antipsychotics may die sooner than those who don't use these drugs. Examples of these antipsychotics include haloperidol, olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).

Antianxiety medicines

Antianxiety medicines, including minor tranquilizers, relieve anxiety and mild agitation and may help calm the person. But they can cause drowsiness if the dose is too high. When minor tranquilizers are needed, short-term or occasional use often is better than continuous use.

Oxazepam and lorazepam (Ativan) are minor tranquilizers sometimes used to treat dementia. Another antianxiety medicine called buspirone also can be tried.

  • These medicines may increase confusion and upset the person's balance. This raises the risk of falls.
  • A person may become dependent on these medicines over time, causing even worse symptoms when he or she suddenly stops taking them. To avoid this problem, these drugs usually are stopped gradually after a few weeks of use.

Anticonvulsant medicines

Anticonvulsant medicines, such as carbamazepine (Tegretol) or valproic acid (Depakene), may be used to control agitation, violent behaviour, and mood swings caused by dementia.

Other medicines

Other medicines that may be used to treat agitation include trazodone or a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), or escitalopram (Cipralex). But research on the effectiveness of these medicines in Alzheimer's disease and other dementias is limited.

Health Canada and U.S. FDA advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

See Drug Reference for more information about all of these medicines. (Drug Reference is not available in all systems.)

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Peter J. Whitehouse, MD - Neurology
Last Revised January 11, 2011

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