Get creative to manage dementia-related behaviors
Heed ‘unspoken messages’ before weighing antipsychotics.
Mrs. A, age 82, has advanced Alzheimer’s disease and has resided in a nursing home for 2 years. She does not recognize that she lives in a nursing home and waits by the door for her son to take her home. She spends her days weeping, telling visitors and staff she has been abandoned and must go home to care for her children.
Recently she has been wandering from the facility. When staff attempt to direct her away from the door, she resists, becomes physically aggressive, and hollers loudly. Her behavior bothers visitors and other patients, who frequently complain.
Her primary care physician prescribes a trial of olanzapine, 10 mg/d, but she becomes confused and suffers a fall. Staff report that Mrs. A is sleeping poorly and losing weight.
Deciding how to manage agitation, aggression, or psychotic symptoms of dementia is dicey at best. You can try an atypical antipsychotic despite the FDA’s black-box warning (Risks of using vs. not using atypical antipsychotics. Current Psychiatry 2005;4(8):14-28.
- Carbamazepine • Carbatrol
- Donepezil • Aricept
- Lorazepam • Ativan
- Memantine • Namenda
- Mirtazapine • Remeron
- Olanzapine • Zyprexa
- Oxazepam • Serax
- Trazodone • Desyrel
- Valproic acid • Depakote
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
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