February 14, 2005
Alzheimer's erodes memory, a painful ordeal for anyone afflicted with the disease, but problem behaviors such as agitation and aggression add to the burden of caring for this difficult illness. Medications provide only limited benefits for such problem behaviors, doctors have found. Caring for someone with Alzheimer's requires patience and special strategies. Alternative therapies such as playing music, aromatherapy, and pet therapy may provide some additional help.
Although memory loss is a hallmark of Alzheimer's, problem behaviors occur in well over half of men and women with the disease. People with Alzheimer's may become agitated and aggressive, kicking and screaming and throwing objects across a room. They may also suffer from delusions and hallucinations, or exhibit a dangerous tendency to wander and get lost. These behaviors can be especially trying for family members and caregivers, adding to the daily stress of coping with and caring for the disease.
Doctors commonly prescribe a wide variety of psychiatric drugs, such as sedatives and psychosis-fighting medications, to help manage these difficult behaviors. Unfortunately, these medications may have only limited effectiveness. Doctors at Wake Forest University School of Medicine in Winston-Salem, North Carolina reviewed 29 rigorous scientific studies that looked at the use of drugs and other treatments for aggression, agitation, and other psychiatric complaints. They found that in many cases, such drugs are not particularly effective for controlling troubling behaviors. Writing in the Journal of the American Medical Association, the researchers advise that lifestyle measures should be tried first for behavior problems in those with Alzheimer's and other forms of dementia.
First and foremost, caregivers should carefully evaluate the home or hospital to look for environmental causes that may be contributing to outbursts. A loud television, distracting noises, even mirrors can frighten and confuse someone with Alzheimer's, leading to disorientation, confusions, fear, and hostile outbursts. Mistreatment can also cause or worsen agitation.
In addition, anyone who has Alzheimer's should be carefully evaluated by a physician. Physical problems such as pain, constipation, infections, depression, or anxiety may be contributing to the problem. In many cases, such problems can be readily remedied. The person affected may feel much better and become much more cooperative and at peace.
Several small studies show that additional lifestyle measures such as music, aromatherapy, and even pets may help ease aggressive behaviors. If someone loves classical music or opera, for example, playing their favorites songs may prove soothing. Aromatherapy, the use of soothing scents, can also prove calming. Even pet therapy--petting a friendly dog or cat--can be helpful to ease anxiety and stress for someone afflicted with Alzheimer's. Finally, it's important that family members and caregivers get counseling and education to help ease the stress and learn ways to help manage someone with Alzheimer's.
Choosing a Drug
In many cases, though, drugs are required to help control outbursts. When it comes to drugs, there is no one-size-fits-all. Your doctor can help decide which might be best for you. If someone is experiencing hallucinations or delusions, for example, your doctor may prescribe an anti-psychotic drug to help combat these symptoms. If on the other hand pacing or repetitive vocal outbursts are the main complaint, this may be a sign of anxiety, and antidepressant drugs may help. Additional findings in the current report included:
Researchers found that two anti-psychotic drugs tended to work better than some of the others for treating outbursts. These drugs were risperidone (sold under the brand name Risperdal) and olanzapine (Zyprexa). Still, benefits were modest, and like many strong drugs, side effects could be serious, including a higher risk of strokes.
The doctors advised against the use of benzodiazepine drugs. These sedatives, commonly prescribed to quell anxiety, might be effective for someone who becomes highly agitated in the short term. But they led to increased confusion and more agitation over the long haul. Regular use of sedatives could also be dangerous for someone with Alzheimer's, as they led to a greater risk for falls.
Physical restraints, such as straps, were also not recommended. The doctors found that rather than providing safety, such restraints actually led to more injuries in people with dementia.
More effective treatments are needed for Alzheimer's disease. Despite your best efforts, outbursts will still occur. Try your best to remain calm and stop whatever it is that you are trying to get your loved one to do. Do not argue or punish the person. He or she may not be able to remember the incident or be able to learn from it because of the nature of Alzheimer's.
If an outburst occurs, talk to the person in a calm and non-threatening manner. Keep your voice low and soothing. If the TV or radio is on, turn it down or off. If someone is upset because they can't find their wallet, for example, spend a few minutes with them helping to look for it. Or, switch to a new activity, like sitting in a rocking chair.
For more on caring for a loved one with Alzheimer's who has become disruptive, see the alzinfo.org story, "Aggression In Persons with Alzheimer's Requires Patience and Care." The Fisher Center for Alzheimer's Research Foundation offers many additional tips for communicating with someone with Alzheimer's disease, traveling with a loved with Alzheimer's, and more.
Kaycee M. Sink; Karen F. Holden; Kristine Yaffe: Pharmacological Treatment of Neuropsychiatric Symptoms of Dementia: A Review of the Evidence." JAMA, February 2, 2005; Volume 293: pages 596 - 608.