Reduce use of behavior-calming drugs for Alzheimer patients?

http://www.eurekalert.org/pub_releases/2015-03/uomh-tt030315.php

Public Release: 3-Mar-2015
University of Michigan Health System

Doctors write millions of prescriptions a year for drugs to calm the behavior of people with Alzheimer's disease and other types of dementia. But non-drug approaches actually work better, and carry far fewer risks, experts conclude in a new report.

In fact, non-drug approaches should be the first choice for treating dementia patients' common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions, say the researchers in a paper just published by the British Medical Journal.

The best evidence among non-drug approaches is for those that focus on training caregivers -- whether they are spouses, adult children or staff in nursing homes and assisted living facilities -- to make behavioral and environmental interventions.

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Kales, however, cautions that penalizing doctors for prescribing antipsychotic drugs to these patients could backfire, if caregiver-based non-drug approaches aren't encouraged.

She and her colleagues from Johns Hopkins, Laura N. Gitlin PhD and Constantine Lyketsos MD, note in their paper that "there needs to be a shift of resources from paying for psychoactive drugs and emergency room and hospital stays to adopting a more proactive approach."

But they also write, "drugs still have their place, especially for the management of acute situations where the safety of the person with dementia or family caregiver may be at risk." For instance, antidepressants make sense for dementia patients with severe depression, and antipsychotic drugs should be used when patients have psychosis or aggression that could lead them to harm themselves or others. But these uses should be closely monitored and ended as soon as possible.

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They also note that many "hidden" medical issues in dementia patients - such as urinary tract infection and other infections, constipation, dehydration and pain - can lead to behavioral issues, as can drug interactions. So physicians should look to assess and address these wherever possible.

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