Medications to Manage Dementia Symptoms

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Medications to Manage Dementia Symptoms

Question:

My mother has dementia. She's in an Alzheimer's facility and in a constant state of anxiety and depression. The number of medications she is on is incredible: Cymbalta, Depakote, Haloperidol, Aricept, Seroquel, Buspar, Trazodone, and Risperdal. They do not control her behavior. Is she at risk for dangerous drug interactions? How can I make sure her therapy is appropriately monitored?

Answer:

Managing dementia in elderly people is very challenging. In addition to the memory loss and other thinking disorders, many people with dementia develop behavioral and psychological symptoms. These may include depression, anxiety, aggressiveness, wandering, and other distressing behaviors.

Unfortunately, there is no cure for Alzheimer's dementia. Medications may help improve some symptoms, but the symptoms will still get worse over time.

People treated with multiple medications, especially drugs that act on the central nervous system, are at higher risk of interactions and side effects. For an elderly person to be receiving the eight drugs you listed would be incredibly dangerous and counter-productive.

There are ways other than using drugs to help people with dementia. Certain tactics can help alleviate some symptoms. This may include maintaining a regular schedule of activities and toileting, engaging in exercise, and listening to music during meals or bathing.

When drugs are used, it is important to understand which symptoms the drug might be treating. You mention several different medication types in your question.

Aricept (donepezil) is used to treat memory loss and problems with thinking. In research studies, people treated with this drug generally had a small improvement in their symptoms (especially memory) although the effect generally only lasts for several months.

Treating the behavioral and psychological symptoms of depression is more difficult. Many people are treated with antipsychotic drugs, but these have major safety concerns. In research studies, some antipsychotic drugs showed small improvements. However, all antipsychotic drugs have been associated with an increased risk of death in the elderly. The Food and Drug Administration issued warnings that this type of drug is potentially risky for older people. Your question listed a few antipsychotic drugs: haloperidol (Haldol), quetiapine (Seroquel), and risperidone (Risperdal). Each is risky on its own for an older person, and should be used with caution. It seems unlikely that a person would be on all three at the same time, but if they were, that would be very unsafe.

Depakote (divalproex) is an anti-seizure drug sometimes used to manage symptoms of agitation in people with dementia. Research has shown that it is no better than a placebo for this problem.

Cymbalta (duloxetine) is an antidepressant, and may be helpful for some elderly people with depression. Buspar (buspirone) can be prescribed as either an antidepressant or an antianxiety drug. Trazodone is sometimes used as an antidepressant, but it also has sedating properties and can be used to help people sleep. It should be used sparingly and in small doses. Each of these three drugs can be useful for certain elderly people. In most cases, these drugs should not be used together because the risk of interactions, over-sedation, and other side effects will increase. This is especially true for a person already receiving multiple other medications.

Last updated:	July 20, 2009