Alzheimer's Behavioral and Psychiatric Symptoms
cont. from
Alzheimer's Definition
When Alzheimer’s disrupts memory, language, thinking and reasoning, these
effects are referred to as “cognitive symptoms” of the disease. The term
“behavioral and psychiatric symptoms” describes a large group of additional
symptoms that occur to at least some degree in many individuals with
Alzheimer’s. In early stages of the disease, people may experience personality
changes such as irritability,
anxiety or
depression. In later stages, other
symptoms may occur, including sleep disturbances; agitation (physical or verbal
aggression, general emotional distress, restlessness, pacing, shredding paper or
tissues, yelling); delusions (firmly held belief in things that are not real);
or
hallucinations (seeing, hearing or feeling things that are not there).
Many individuals with Alzheimer’s and their families find behavioral and
psychiatric symptoms to be the most challenging and distressing effects of the
disease. These symptoms are often a determining factor in a family’s decision to
place a loved one in residential care. They also often have an enormous impact
on care and quality of life for individuals living in long-term care facilities.
Alzheimer's Medical evaluation
A person exhibiting behavioral and psychiatric symptoms should receive a
thorough medical evaluation, especially when symptoms come on suddenly.
Treatment depends on a careful diagnosis, determination of the possible causes,
and the types of behavior the person is experiencing. With proper treatment and
intervention, significant reduction or stabilization of the symptoms can often
be achieved.
Symptoms often reflect an underlying infection or medical illness. For
example, the pain or discomfort caused by pneumonia or a urinary tract infection
can result in agitation. An untreated ear or sinus infection can cause dizziness
and pain that affect behaviors. Side effects of prescription medication are
another common contributing factor to behavioral symptoms. Side effects are
especially likely to occur when individuals are taking multiple medications for
several health conditions, creating a potential for drug interactions.
Non-drug interventions
There are two distinct types of treatments for agitation: non-drug
interventions and prescription medications. Non-drug interventions should be
tried first. In general, steps to managing agitation include (1) identifying the
behavior, (2) understanding its cause, and (3) adapting the
caregiving
environment to remedy the situation.
Correctly identifying what has triggered symptoms can often help in selecting
the best behavioral intervention. Often the trigger is some sort of change in
the person’s environment:
- change in caregiver
- change in living arrangements
- travel
- hospitalization
- presence of houseguests
- bathing
- being asked to change clothing
A key principle of intervention is redirecting the affected individual’s
attention, rather than arguing, disagreeing, or being confrontational with the
person. Additional intervention strategies include the following:
- simplify the environment
- simplify tasks and routines
- allow adequate rest between stimulating events
- use labels to cue or remind the person
- equip doors and gates with safety locks
- remove guns
- use lighting to reduce confusion and restlessness at night
Medications to treat agitation
Medications can be effective in some situations, but they must be used
carefully and are most effective when combined with non-drug approaches.
Medications should target specific symptoms so their effect can be monitored. In
general, it is best to start with a low dose of a single drug. People with
dementia are susceptible to serious side effects, including a slightly increased
risk of death from antipsychotic medications. Risk and potential benefits of a
drug should be carefully analyzed for any individual. Examples of medications
commonly used to treat behavioral and psychiatric symptoms include the
following:
Anxiolytics for anxiety, restlessness, verbally disruptive behavior and
resistance
Antipsychotic medications for hallucinations, delusions, aggression,
hostility and uncooperativeness
Although antipsychotics are among the most frequently used medications for
treating agitation, some physicians may prescribe an anticonvulsant/mood
stabilizer, such as carbamazepine (Tegretol®) or
divalproex (Depakote®) for
hostility or aggression.
Sedative medications, which are used to treat insomnia or sleep problems, may
cause incontinence, instability, falls or increased agitation. These drugs must
be used with caution, and caregivers need to be aware of these possible side
effects.
continue: Alternative Treatments for Alzheimer's
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Reviewed: 03/2006
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