How Anti-Dementia Drugs Used to Relieve Behavioural and Psychological Symptoms of Dementia

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Behavioral and psychological symptoms of dementia are very common and usually, develop as the disease progresses. There is increasing evidence that for some people the anti-dementia drugs may be an effective treatment for behavioral and psychological symptoms of dementia.

People with dementia may develop behavioral and psychological symptoms including restlessness, aggression, delusions, hallucinations, apathy and sleep disturbances. This factsheet looks at the different types of drugs that can be used to treat these symptoms if non-drug treatments have not worked. It explains when and how they should be prescribed and what the side-effects might be.

When should anti-dementia drugs be used to treat behavioral and psychological symptoms in dementia?

Memantine has the advantage of being a safe treatment, with other benefits for daily living and memory. Further research is still needed to confirm how effective memantine is in treating behavioral and psychological symptoms but the evidence shows it is more effective than using antidepressants or anticonvulsants.

The other anti-dementia drugs – donepezil, rivastigmine, and galantamine – are known as cholinesterase inhibitors. Cholinesterase inhibitors, particularly rivastigmine and donepezil, may reduce the severity of some behavioral and psychological symptoms of dementia and help delay their onset. Cholinesterase inhibitors are especially effective in Lewy body dementia and dementia related to Parkinson’s disease in treating agitation, apathy and psychotic symptoms.

According to NICE guidelines, people with Lewy body dementia should be offered cholinesterase inhibitor treatment only if their behavioral and psychological symptoms are causing them significant distress. People with Alzheimer’s disease may also be offered cholinesterase inhibitor treatment for distressing behavioral and psychological symptoms. However, this is provided that non-drug approaches and antipsychotic drugs have already been tried and were ineffective, or they haven’t been tried but are thought to be inappropriate. People with dementia that is entirely due to vascular disease and is not a mixed form (dementia that is caused by both vascular disease and Alzheimer’s disease) should not be prescribed cholinesterase inhibitors for behavioral or psychological symptoms.

Other drugs to treat dementia symptoms

Before medication is considered, any person with dementia who develops behavioral and psychological symptoms should be offered an assessment by their GP at an early opportunity. This assessment should try to establish any possible underlying factors that may have triggered or may be aggravating the person’s symptoms.

  • Antipsychotic drugs (also known as neuroleptics or major tranquillisers) for treating agitation, aggression and psychotic symptoms;
  • Antidepressants and anticonvulsants for symptoms of depression and anxiety;
  • Hypnotics (drugs to avoid sleep disturbances).

It is important to ensure that the person with dementia is physically healthy, comfortable and well cared for. The person should also be helped to lead an active life, with interesting and stimulating daily activities. In this way, it is often possible to avoid the use of drugs altogether.

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