Medications Used to Treat Difficult Dementia Related Behavior

What are the challenging new behaviors?

• Delusions, Paranoid behaviors or irrational beliefs, impaired insight and judgement, memory

• Refusing to bathe or change clothes

• Agitation/ yelling/ hitting caregivers/residents

• Restless Pacing /wandering/exit seeking

• Disinhibited behaviors- socially inappropriate sexual behavior/disrobing

• Sleep Disturbance

What are the ways to manage the challenging behaviors?

• Redirection and de-escalate difficult behaviors

• Keep a journal to identify triggers

• Identify taste, smells, touch that are soothing/irritating

• Assess for pain /constipation

• Assess for urinary tract infection

• Consider if person is depressed- don’t use antipsychotics as first choice

• Teepa Snow : Caregivers Guide and other books/videos

What to know about the medications for dementia?

• There are no FDA approved medications to treat difficult behaviors of dementia

• Weigh risks and benefits of using psychotropic medications

What are the antipsychotic drugs?

• Quetiapine (Seroquel)

• Olanzapine (Zyprexa)

• Aripiprazole (Abilify)

• Haloperidol (Haldol)

• Risperidone (Risperdal)

• *Brexpiprazole (Rexaulti)

What are the benzodiazepines?

• Can agitate them if prescribed on a daily basis

• Lorazepam (Ativan)

• Temazapam (Restoril)

• Diazapam (Valium)

• Alprazolam (Xanax)

• Clonazepam (Klonapin)

What drugs are mood stabilizers?

• Most commonly used :

  • Valproic Acid   (Depakote)  capsule (sprinkles ) or long acting

  • Lamotrigine (Lamictal)

• Note : Lithium is most common mood stabilizer (Bipolar Disorder ) but not used in assisted living.

What are the antidepressant drugs?

• SSRI (Selective Serotonin Reuptake Inhabitors)

• Escitalopram   (Lexapro)

• Citalopram     (Celexa)

• Sertraline   Zoloft

• Paroxitine (Paxil)

• Mirtazapine (Remeron)

• Trazodone (Deseryl) for sleep

• Duloxetine (Cymbalta) SNRI

What are the side effects of the medications?

• Complicated by Polypharmacy: Which medication is the culprit???

• Dry mouth, Constipation, (anticholinergic)

• Weight gain

• Dizziness, Sedation, Ataxia, Weakness

• Headache

• Insomnia

• Postural Hypotension

• Nervousness, anxiety

• Withdrawal type symptoms when medication is discontinued

• Tardive Dyskinesia, Akathesia (abnormal movements)

What are the positive effects of the medications?

• Feeling of wellbeing

• Mood stabilization

• Decrease in paranoia, hallucinations

• Less anxiety/worry/depression

• Participation in activities

• Improved sleep and appetite

• Accepts care from caregivers/family