Dementia: Medicines to Treat Behaviour Changes

British Columbia Specific Information

In British Columbia, people with dementia and their families have access to information and support to make informed choices about their long-term care. First Link^® is an early intervention service designed to connect individuals and families affected by Alzheimer's disease or another dementia with services and support as soon as possible after diagnosis. For more information on First Link^® visit Alzheimer Society – FirstLink^® form referrals.

The Ministry of Health, in collaboration with physicians and nurses from across B.C., has developed the Best Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in Residential Care. The guideline includes a useful algorithm and is intended to support health care providers when they provide care and support to people with Alzheimer’s or other dementia and their families.

If you or a loved one are having difficulty coping with activities of daily living because of a health-related problem such as dementia, A Guide to Your Care (PDF 1.66 MB) may help you. The guide has information about home and community care services to help British Columbians live as independently as possible. For additional information on home and community care services in B.C. including care options and cost, who pays for care, eligibility requirements, and how to arrange care, visit the Home & Community Care website.

For more information about health care service delivery, visit The Alzheimer Society's Guidelines for Care: Person-Centred Care of People with Dementia Living in Care Homes Framework (PDF 526 KB), or the British Columbia Psychogeriatric Association's resource Meeting Seniors' Mental Health Care Needs in British Columbia: A Resource Document (PDF 1.66 MB).

Overview

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 who have dementia include aripiprazole, haloperidol, and risperidone.

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.

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.

Lorazepam and oxazepam are minor tranquilizers sometimes used to treat the symptoms of 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 medicine

Anticonvulsant medicine, such as valproic acid, 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 antidepressants. Trazodone and serotonin reuptake inhibitors (SSRIs) such as citalopram, fluoxetine, and sertraline are examples. But research on the effectiveness of these medicines in Alzheimer's disease and other dementias is limited.

Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.

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

Credits

Current as of: October 20, 2022

Author: Healthwise Staff
Medical Review:
Anne C. Poinier MD - Internal Medicine
Brian D. O'Brien MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Myron F. Weiner MD - Psychiatry, Neurology

Alzheimer Society of British Columbia: First Link Dementia Helpline

The First Link® Dementia Helpline is for anyone affected by dementia, whether professionally or personally. If you have questions about Alzheimer's disease or other dementias, call the Alzheimer Society of B.C.'s First Link® Dementia Helpline for information and support (toll-free):