TREATMENT OF BEHAVIORAL PROBLEMS ASSOCIATED WITH DEMENTIA

Abstract

Both dementia and depression in the elderly patient may be accompanied by severe agitation or other behavioral disorder. These behaviors may be extremely difficult to treat safely and effectively in this special population and frequently are the precipitants for admission to the nursing home. Up until relatively recently the pharmacological treatment for these behaviors has been limited, with a frequent usage of benzodiazepines and older antipsychotics. Several of the frequently employed benzodiazepines have extremely long half lives that may compromise the cognitive function of these already cognitively impaired individuals, and even those benzodiazepines with intermediate half lives may be potentially dangerous for older adults, given the potential for serious adverse side effects such as daytime sedation, dizziness, and falls. Alternative nonbenzodiazepine anxiolytic medications such as buspirone and trazodone are now available and offer equivalent efficacy with less potential deleterious side effects, and these will be discussed in detail. The use of selective serotonin reuptake inhibitors (SSRIs) has been described in several case reports noting a reduction in agitation in patients with dementia. The use of SSRIs for patients with agitation, with or without noted depression, may afford the agitated dementia patient the opportunity to experience a reduction in agitation without the potential for serious side effects of benzodiazepines or neuroleptics. Lithium and carbamazepine have been used for agitation in younger adults but pose a potential for greater side effects in older adults. Divalproex is therefore now being used more frequently for these populations. The older antipsychotics have frequently been responsible for significant adverse side effects in elderly patients including extrapyramidal side effects including tardive dyskinesia. The newer novel antipsychotics afford this special population the possibility of similar efficacy without the same degree of adverse effects. All of these issues are reviewed and discussed.