Anti-Psychotic Medicines and Dementia

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This page shares excerpts and links for caregivers who want to understand more about using anti-psychotics for dementia behavior. It provides links to pages from the Alzheimer’s Society, UK and Alzheimer’s Association, USA. Caregivers can read these to prepare for the discussion with their doctors.

Most persons with dementia experience behavioural and psychological symptoms (BPSD) (examples: aggression, agitation, loss of inhibitions, delusions, etc) and these can be distressing or harmful. Concerned families seek treatment and anti-psychotics may be prescribed. Families need to know the pros and cons to be able to discuss such treatment with doctors, because such medication may not be helpful and can even harm, and experts believe that anti-psychotics are prescribed more often than necessary for dementia cases.

For example, Alzheimer’s Society, UK, discusses the over-prescription of antipsychotics[1]. An excerpt (reconfirmed in March 2023).

People with dementia who experience BPSD are often, and inappropriately, prescribed antipsychotic drugs used to treat schizophrenia. Antipsychotic drugs do reduce psychotic experiences such as delusion. However, they are also linked to serious side effects, have a moderate benefit and do not address underlying causes of BPSD. A Department of Health study concluded of the 180,000 prescriptions for people with dementia overall, 140,000 are inappropriate.

The page explains that people with dementia are at a high risk of dangerous side effects. Some more quotes from the same page (reconfirmed March 2023).:

Inappropriate prescription of antipsychotic drugs is extremely harmful. Research has shown that there is up to a 9-fold risk of stroke in the first four weeks (Klijer, 2009) and that there is almost a doubling in the risk of mortality (Food and Drug Administration, 2005). Inappropriate prescription of antipsychotic drugs contributes to 1,800 deaths a year death (DH, 2009a).

The Alzheimer’s Society goes on to recognize that treatment and care must be improved and use of drugs reduced, and suggests use of holistic assessments, individual care plans with interventions tailored to the person’s preferences, such as activities that are based on an individual’s hobbies and interests, etc. Involving the person and families in decisions about treatment, and regular reviews of medications are recommended. As the page states reconfirmed March 2023):

The point must be reached where antipsychotic drugs are only prescribed to people with dementia when necessary and appropriate.

The Alzheimer’s Association, USA, on its page, Treatments for Behavior[2] suggests guidelines for considering/ using antipsychotics. An excerpt (reconfirmed in March 2023).:

Based on scientific evidence, as well as governmental warnings and guidance from care oversight bodies, individuals with dementia should use antipsychotic medications only under one of the following conditions:
• Behavioral symptoms are due to mania or psychosis
• The symptoms present a danger to the person or others
• The person is experiencing inconsolable or persistent distress, a significant decline in function or substantial difficulty receiving needed care.
Antipsychotic medications should not be used to sedate or restrain persons with dementia. The minimum dosage should be used for the minimum amount of time possible. Adverse side effects require careful monitoring.

Note that some common anti-psychotics can cause severe damage if given to someone with Lewy Body Dementia [3]. (Excerpt below, reconfirmed March 2023).:

IMPORTANT NOTE: It is estimated that a high percentage of DLB patients exhibit worsening parkinsonism, sedation, immobility, or even neuroleptic malignant syndrome (NMS) after exposure to antipsychotics. NMS is a rare, life-threatening medical emergency characterized by fever, generalized rigidity, and breakdown of muscle tissue that can cause renal failure and death. The heightened risk of NMS in DLB mandates that typical or traditional antipsychotics (such as haloperidol, fluphenazine or thioridazine) should be avoided.

Unfortunately, persons with Lewy Body Dementia are often misdiagnosed as having Alzheimer’s Disease. As a result, they may be given medicines that harm them. Any use of anti-psychotic medication requires great care and review.

Documents referred to above

This page is referred to from: Handling Behavior Challenges.

[The information on this page is a collation from standard, authoritative sources, provided only for convenience. Caregivers can check out these and other sources to get better informed about this topic.]

Dementia Care Notes