Working in geriatrics, you get an appreciation (unfortunately) for how devastating the disease can be. Medications play a significant role in dementia as well as how they are utilized. Here are 5 common medication concerns in dementia that I have seen in my practice and that you need to think about in any patient with this diagnosis.
Ability to Manage Medications
Early in the disease, there is this very gray line as to whether the patient has the ability to perform tasks (often called activities of daily living or instrumental activities of daily living). I outline these tasks more in-depth in our Geriatric Study Material, but one of those IADLs is managing medications. Patients with life-threatening and often complicated conditions like atrial fibrillation, COPD, asthma, and diabetes can have complicated drug regimens to follow. You have to review this with your patient and ensure that there is a simple plan that they can follow or someone who is going to be administering their medications for them.
Drugs That Cause Dementia Like Symptoms
As a pharmacist, one of the biggest medication concerns in dementia is other medications. Many times, dementia patients are polypharmacy patients. This can easily lead to a situation where we are doing more harm than good by having the patient on cognitive impairing medications. Drugs with anticholinergic and CNS depressant activity are two major categories of medications that I look at to ensure that these aren’t causing or contributing to dementia symptoms. Some examples (not all inclusive) of medications that can alter cognition and mental clarity include; hydroxyzine, diphenhydramine, dicyclomine, TCA’s, cyclobenzaprine, topiramate, phenytoin, opioids, gabapentin, etc. Many of these medications are found on the Beers criteria which was recently updated.
Psychotropic Medications For Behaviors
At some point in a patient’s dementia process, there may be situations where a patient may “act out”. Physical acts like hitting, pinching may occur. Yelling and repetitive noises can also be challenging for caregivers. It is critical to avoid turning to the prescription bottle as a first option. Many patients with dementia are unable to specifically say what they need. It can be difficult work to try to identify what is going on with the patient, but we must use non-drug interventions prior to even thinking about using medications.
Here’s where we can have to get creative. Patients who have difficulty swallowing can obviously have difficulty taking oral dosage forms. Controlled release medications often cannot be crushed and mixed in with anything. This is a great opportunity as a pharmacist to try to help resolve administration questions and provide alternative solutions if a medication needs to be switched.
Along with those swallowing difficulties, patients can begin to have trouble with eating and begin to lose weight. This can obviously be caused by their dementia symptoms, but we must recognize that there are medications that can cause weight loss. One of the most common classes of medications used for symptom improvement in dementia is the acetylcholinesterase inhibitors. Drugs like donepezil and rivastigmine have the potential to cause weight loss. We need to be aware of this and ensure that we know whether dementia is causing weight loss or if it is an adverse effect.
Hopefully knowing these medication concerns in dementia will help you help those who are dealing with a patient with this challenging diagnosis.
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