This is arguably one of the greatest challenges in the elderly. I nearly daily get asked questions about behaviors associated with dementia. Often these patients can be aggressive, hit, spit, kick, swear, hallucinate, be sexually inappropriate, or have delusions. I was once asked what the best medication is to treat these behaviors. I relate that question to what is the best antibiotic to use. If there was one miracle medication that worked, every patient would be on it. It really depends upon what you are trying to treat, and often we can do an adequate job of treating these behaviors without medications or at least by thorough assessment of the patient in identifying the root cause of the behavior.
There are many questions to ask when assessing new or abnormal behavioral symptoms. Here’s just a few to focus on from the start:
1. Identify the specific behaviors and be sure to relay this information to the clinicians/caregivers who are helping in making decisions.
2. When did these behaviors start and what time(s) of the day do they happen?
3. Can we correlate the start of new behaviors to anything else? (i.e. fall, medication, stroke, family crisis, infection, change in environmental factors etc.)
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Eric: Great topic. Yes, whenever possible, treat with behavior modification rather than mediation. That said, medications are sometimes necessary. If medications are necessary we need to follow a couple of extremely important rules.
1. Check the dose. We want to start at a very low dose in elderly folks because their potential for side effects is significantly increased.
2. Neurotransmitter adjustment therapy is not a “set-it-and-forget-it” dosing process. Patients, caregivers and family need to realize it may take 7-14 days before we get to where we want to be, and during this acclimation period there may be a slight exacerbation of symptoms at times. Everyone needs to realize that sometimes the patient just needs to “hold on” for a few days until they begin to change how they are feeling.
3. It is important to know what outcome we are looking for so we will know when we get there. If we don’t know exactly where we want to be, we definately won’t know when we arrive.
4. Regular monitoring of outcome results so we know when it is time to decrease and stop the therapy. In other words, regular check up’s to see if the positive benefits of therapy are worth the side effects of the medication.
Thanks
Steve
Good article. I would like to see us learn from all the research done in the Netherlands. Particularly the use of medical marijuana is an important avenue to investigate for dementia related behaviors.