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Treating Disruptive Behaviour in People with Dementia: Antipsychotic drugs are usually not the best choice

People with Alzheimer’s disease and other forms of dementia can become restless, aggressive, or disruptive. They may believe things that are not true. They may see or hear things that are not there. These symptoms can cause even more distress than the loss of memory.

Health care providers often prescribe powerful antipsychotic drugs to treat these behaviours:

If you are uncertain if your loved one is taking one of these medications please ask their health care team.

In most cases, antipsychotics should not be the first choice for treatment, according to the Canadian Geriatrics Society. Here’s why:

Antipsychotic drugs don’t help much.

Studies have compared these drugs to sugar pills or placebos. These studies showed that antipsychotics usually don’t reduce disruptive behaviour in older dementia patients.

Antipsychotic drugs can cause serious side effects.

Health care providers can prescribe these drugs for behavioural symptoms that occur in dementia, but they cause serious side effects.

Side effects include:

Other approaches often work better.

It is almost always best to try other approaches first, such as the suggestions listed below.

Make sure the patient has a thorough exam and medicine review.

Talk to a behaviour specialist.

This person can help you find nondrug ways to deal with the problem. For example, when someone is startled, they may become agitated. It may help to warn the person before you touch them. The box at right provides more tips.

Consider other drugs first.

Talk to your healthcare provider about the following drugs that have been approved for treatment of disruptive behaviours:

Consider antipsychotic drugs if:

Start the drug at the lowest possible dose. Caregivers and healthcare providers should watch the patient carefully to make sure that symptoms improve and that there are no serious side effects. The drugs should be stopped if they are not helping or are no longer needed.

Tips to help with disruptive behaviours.

Keep a daily routine.

People with dementia often become restless or irritable around dinner time.

Help the person exercise every day.

Physical activity helps use nervous energy. It improves mood and sleep.

Don’t argue with a person who’s distressed.

Plan simple activities and social time.

Boredom and loneliness can increase anxiety. Adult day programs can provide activities for older people. They also give caregivers a break.