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Exploring Recent Advances in Medications for Managing Agitation in Dementia

In a brief conversation today with my friend, Sayi Effraim, owner of Restore 360 (https://restore360.org/) I learned a little more about the ever growing field of behavioral health as it pertains to dementia and the elderly.




As we all know, dementia isn't a one size fits all, and despite Alzheimer's Disease being the leading cause of dementia in the elderly, it is not the only type of brain loss that can cause confusion, loss of short term memory, agitation and loss of ability to care for oneself or perform the activities of daily living. Vascular dementia, which robs the brain of life sustaining oxygen, is responsible for certain symptoms, and Parkinson's disease can also cause dementia and the related symptoms. This is why it's important to understand and have a full neurological work-up if you or a loved on is experiencing memory loss. The more information the primary care physician and behavioral health practitioners have, the better they can treat the symptoms with many new medications out on the market.


In my experience, I have seen families struggle while watching their aging loved ones decline rapidly with Alzheimer's or vascular dementia, especially if there is a behavioral component and the loved one is suffering from hallucinations and/or increased agitation. I have never been an advocate of throwing benzodiazepine medications at the problem to knock the patient or resident out, but I have seen it done time and time again, to the relief of the caregivers and detriment of the patient. Fortunately there are much more effective medications on the market now for agitation related to dementia that will allow the resident or patient to live a better quality of life. Benzo dosing for agitation is considered a medical restraint and is not only frowned upon in the long term care jurisdiction but also goes against regulation.


The problem with Benzos for the elderly:




Benzos tend to calm the patient but can also strip away any ability for them to participate in their activities of daily living such as walking, washing or even eating. It's with great desperation that a family member would rather have their loved one be a calm and wheelchair-bound zombie, but it's important to know that this isn't always the only answer, but it tends to be the quickest way to solve the immediate problem. It can often be the common answer for group living, such as nursing homes or memory care neighborhoods where the agitation of one patient affects everyone on the floor. If the wellness director cannot take care of a resident because they are so agitated or they are a danger to themselves or other residents, the choice is often made by a medical director to give them Benzos as needed, which can be often if they aren't addressing the underlying problem. Also, Benzos are addictive and can lead to withdrawal symptoms down the line, which can obviously lead to other health issues and concerns.


This is why I will reiterate that having a trained geriatric behavioral health practitioner involved is important. They know more about the advancements in behavioral health medications for the elderly and how they can address the underlying problems rather than just tranquilizing the patient. Seyi will communicate with nursing and care staff and look at the medication list and any notes upon her arrival to see a patient. She will try to ween a patient off of Benzos and will work with anti-depressants combined with newer iterations of anti-psychotics such as Rexulti (https://www.rexultihcp.com/), or Abilify (https://www.abilify.com/) in low doses and has found that it has been incredibly beneficial for her elderly dementia patients who have aggressive tendencies or increased agitation.


It's also important to keep in mind that a change in medications can take up to a month to see final results, so there may be a need to ween them off of their benzos slowly. Seyi recommends a slow titration to full recommended dose of any behavioral health medication to ensure that side-effects aren't counter-intuitive as they can also be dangerous. For example, one of the side effects of Abilify is restlessness. If a patient has a history of anxiety, this might not be the best choice for them.


If your loved one has Parkinson's Dementia Psychosis (PDP), you may need to seek other options such as NuPlazid, which is specifically for Parkinson's related Dementia with hallucinations and isn't currently recommended for any other forms of dementia. Testing is currently taking place for use in other forms of dementia and the results are promising. https://www.nuplazidhcp.com/home.


Just knowing that the medication advancement are out there and there might be answers for those suffering from agitation related to dementia gives hope to anyone who struggles to find the best care for their loved one. Don't settle for straight benzos and definitely continue to advocate for the best doctors and treatments for your loved one who suffers from dementia with agitation.




Pharmacogenomics (PGx) is another option that can help pinpoint which medications will work best with you or your loved one's DNA. Dr. Chana Hershkop, experienced Geriatric Pharmacist and PGx certified owner of Golden Health Consulting https://goldenhealthconsulting.com/ is able to help patients accurately target the medications that work best with their DNA. This service can help avoid bad side-effects and the trial and error method of behavioral health medication monitoring. The test is simple and requires only a cheek swab. Patients can mail this to the lab and have the results quickly. Follow up consultation then offers explanation of the findings and Chana can help the patient utilize the best medication for their genetic make-up. Consultation can be done over the phone or internet or in person if you are in the greater Philadelphia area.


I always recommend trying to find a reliable behavioral health practitioner to follow your loved one. Keep in mind that just because they don't have a history of behavioral health issues, doesn't mean that they don't need help now. If they struggle with depression, which is very common with any form of dementia, they may see increased viability with a low dose of an anti-depressant to start. Knowing which anti-depressant will work best for their DNA will also help to avoid extending any suffering or negative side-effects.


We know that any form of memory loss is frightening for not only the sufferer but also the family and support network of caregivers. The better we can advocate for those who can no longer advocate for themselves, the better outcome for everyone in the wheel of care. Continued education is key if your loved one is suffering.

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