Of the many symptoms arising in people with dementia or Alzheimer’s disease, the ones most commonly treated by medication are anxiety, restlessness and aggression. All these symptoms can be distressing and frightening for the person with dementia and for their carer.
Sometimes a carer will have read or been told that it should be possible to control symptoms without using drugs, but this may not take into consideration the desperation felt by carers unable to find a way of managing difficult behaviour.
NICE guideline NG97 June 2018 suggests that before starting treatment for distress in people living with dementia a structured assessment is made to:
- explore possible reasons for their distress, and;
- check for and address clinical or environmental causes (for example pain, delirium or inappropriate care).
Many carers are sure that without some kind of medication it would be impossible for them to carry on and suggest, probably rightly, that the people who believe they should manage without medication have not experienced the day-in day-out stresses of caring for a person with dementia.
Describes how she came to accept that her partner needed some sedation.
Some of the medications used tend to have a sedative effect and the carer needs to balance the need to control the symptoms and the risk of turning someone into a zombie. Many carers expressed a fear that, by sedating their loved one, they are losing their last chance of contact with the person they used to know.
Carer recognises that her mother needs medication to relieve her anxiety but is unhappy that it makes her sleep all the time.
Carer felt that when her husband was in hospital for two weeks he was over sedated.
Many carers discovered for themselves or through their medical advisor a system whereby they tailored the use of sedative medicines according to the immediate situation and the time of day.
Describes how he tailors his wifes sedation according to her condition at the time.
In some cases, people in the early stages of dementia were mistakenly thought to be suffering from depression and were given antidepressants which sometimes made things worse. Antidepressants are however sometimes used for people with established dementia, as a co-existing depression is quite common. Antipsychotics drugs are a group of medications that are also occasionally prescribed for behavioural (aggression) and psychological symptoms in dementia. Antipsychotic drugs carry an increased risks and side effects, so are used very cautiously to help with behavioural and psychological symptoms in dementia.
Possible side effects of antipsychotics include:
- sedation (drowsiness)
- parkinsonism (shaking and unsteadiness)
- increased risk of infections
- increased risk of falls
- increased risk of blood clots
- increased risk of ankle swelling
- increased risk of stroke
- worsening of other symptoms of dementia
- increased risk of death.
When antipsychotic medication is indicated, the doctor will weigh up the pros and cons of the prescription with the patient, carers and others concerned before making a decision. If antipsychotics are prescribed, the patient should be closely monitored and the medication stopped as soon as clinically indicated.
Many carers mentioned music as a source of pleasure and as a calming influence. While it may not actually do away with the need to use medication it can bring relief both to the carer and to the person with dementia. Other forms of non-drug treatment such as reminiscence therapy, social interaction, aromatherapy, talking therapies, animal therapy, dance therapy and massage are also suggested by the Alzheimer’s Society and NICE as alternatives and should be used before medication is prescribed.