The hot buzz on the Internet today is about the misuse of anti psychotic drugs to treat Alzheimer's.
The use of antipsychotic drugs to "control" difficult behavior, agitation, outbursts and sometimes combative behavior of dementia and Alzheimer's patients is soaring. Sales of newer antipsychotics like Risperdal, Seroquel and Zyprexa have more than tripled to $14 billion, up from $4 billion in 2000, according to currently available statistics. Most of this increase can be traced to prescriptions in nursing homes. Current estimates indicate that about one-third of all nursing home patients have been given antipsychotic drugs. Yikes.
There are at least seventeen studies of elderly people with dementia that compared patients taking an anitpsychotic drug with those taking a placebo. These studies indicate that patients taking the drugs die at a rate almost two times the rate of patients taking the placebo over the course of the study.
Subscribe to The Alzheimer's Reading RoomI am not a doctor so I decided to look in my copy of The Alzheimer's Action Plan: The Experts' Guide to the Best Diagnosis and Treatment for Memory Problems to see if it contained any advice on how to deal with this issue. I was pleased to learn that the federal government has developed guidelines that doctor's must follow when prescribing these drugs. The guidelines cover the following mistakes that are often made by doctors:
If you look beyond the obvious on the studies being done on anti psychotic medications and dementia you will be surprised to learn that 30 to 60 percent of patients in the placebo groups improved. It seems to me that the likely explanation of this is that these patients are responding because they are receiving lots of personal "attention". I'll take this a step further. When a now "fired" personal physician tried to put my mother on an anti psychotic medication before she was diagnosed with Alzheimer's I said, "No". I had read several of the articles on this issue and I wanted to make sure that I didn't do anything that would worsen her situation before we actually knew the real extent and reason for the problem.
- prescribing anti psychotic drugs to treat minor behavior problems such as occassional insomnia, mild anxiety, or wandering
- prescribing an anti psychotic drug over the telephone without seeing the person
- start someone on an anti psychotic drug without going over the risks of the drug with family members
- recommend a combination of anti psychotic drugs
- continue anti psychotic drugs for months after the behavior has improved
- put someone on anti psychotic medication but fail to monitor for neurological problems such as stiffness or tics, weight changes, or hormonal or cholesterol problems
- promise the drugs can keep Alzheimer's from getting worse as quickly
- say the newer anti psychotic medications are far superior to the older (less expensive) versions (Source: The Alzheimer's Action Plan, page 324)
Early on, my mother was evidencing peculiar behavior(s) that I had never seen in her before. She was flying off the handle, she was being mean to me, and she was saying things that I cannot repeat in print. I knew something was dramatically wrong. Eventually, we identified a wonderful personal physician that was familiar with dementia and Alzheimer's disease. He took us through all the identification steps and then prescribed Aricept. The Aricept did and has helped. There are several studies that show that drugs like Aricept are being underutilized in the treatment of Alzheimer's.
Research shows that 10 to 20 percent of Alzheimer’s patients had noticeable positive responses to the drugs, and 40 percent more showed some cognitive improvement, even if it was not noticeable to an observer.The real difference for my mother and me came when I read The Validation Breakthrough: Simple Techniques for Communicating with People with 'Alzheimer's. This book convinced me I could develop good communication techniques to get my mother's erratic behaviors under control. It worked. I am not trying to tell you everything is a bed of roses; I am confident in saying that you can do something about these erratic behaviors if you can learn the appropriate communication techniques.
There were other developments im my mother's diagnosis and treatment. It turned out my mother was suffering from hypothyroidism. Hypothyroidism can present as Alzheimer's or depression. Once our doctor prescribed the appropriate thyroid medication my mother's behavior made an additional dramatic change for the good. I suggest if you are caring for someone suffering from Alzheimer's that you get their thyroid checked.
The best advice I can give to caregivers is to be sure that your personal physician is well versed in dementia and Alzheimer's--most are not. The quality of life for both the patient and the caregiver can be dramatically affected by a well educated personal physician. Sadly, I have learned over the last five years that few heed this advice.
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Original content Bob DeMarco, the Alzheimer's Reading Room
