Treatment of the agitated demented elderly patient.

Abstract

One of the most common and hard-to-treat symptoms of demen- tia in the elderly is severe agitation. Usually seen in a nursing home or a hospital when dementia is severe, agitated behavior taxes the patience of the caretaking staff. Demented older people may rock, moan, scream, and wander, and, if not restrained, can become as- saultive, self-destructive, and vio- lent. Agitation is often worse at night, when it is called sundown- ing. Hazards. Both dementia and the aging process increase the older patient's sensitivity to the side effects of neuroleptics (3). Extrapyramidal symptoms, orthosta- tic hypotension, sedation, and an- ticholinergic symptoms are all more common and more severe when neuroleptics are given to older demented patients. Sedation may be long lasting due to de- layed elimination of these drugs in older patients. Anticholinergic symptoms may worsen dementia and produce increases in confu- sion, disorientation, memory loss, and agitation. That is especially true when neuroleptics are used in conjunction with other anticholin- ergic drugs. Recommendations. Very low doses of neuroleptics should be employed for treatment of agita- tion in the elderly. For example, if a nonsedating neuroleptic such as haloperidol or fluphenazine is to be used, then doses of one- quarter mg to one-half mg three to four times a day may be suffi- cient. If a sedating neuroleptic such as thioridazine is to be used, then doses of 10 mg three or four times a day may be sufficient. These doses may be obtained by drawing up the appropriate amounts of liq- uid preparations of the neurolep- tic in a syringe and dissolving the