(HOME PAGE)

About Dementia:
➢ Dementia is a broad term used to describe various symptoms that can be caused
by disorders of the brain. A person who suffers from dementia typically loses
their ability to control their emotions, solve problems and maintain their behavior.
A common ​irreversible ​symptom is the loss of memory​; ​ however​,​ doctors do not
specifically use memory loss to diagnose an individual with dementia unless two
or more brain functions are affected. ​“The number of people worldwide living
with Dementia is approximately 47 million and is expected to increase to
approximately 75 million by the year 2030” (10 facts on Dementia)
➢ Diseases that can cause symptoms of dementia:
○ Alzheimer’s Disease
○ Vascular dementia: ​C​aused by a series of small strokes​, and is the ​2nd
most common cause of Dementia​.
○ Lewy Body Dementia: Begins between the ages of 50 and 85. Happens
when abnormal structures, called Lewy Bodies, build up in areas of the
brain. No cure for this, however treatments are used to reduce symptoms.
○ Frontotemporal Dementia: Describes a clinical syndrome associated with
shrinking of the frontal and temporal lobes. This results in changes of
behavior or problems with language
○ Huntington’s disease: Causes nerve cells in your brain and spinal cord to
deteriorate. Symptoms usually appear in your 30s or 40s
○ Creutzfeldt-Jakob disease: A rare brain disorder that can be inherited or
generated from exposure to diseased brain or nervous system tissue. This
condition is fatal and symptoms usually appear around the age of 60
○ Parkinson's Disease: A clinical diagnosis related to Lewy Body Dementia.
This affects a person’s memory, social judgement, language and
reasoning.
➢ Other conditions that can cause dementia-like symptoms:
○ Brain tumors
○ Anoxia or hypoxia
○ Endocrine abnormalities
○ Nutritional deficiencies
○ infections
➢ NOT A PART OF THE NORMAL AGING PROCESS
About BPSD:
Possible video?

(non-pharmacological interventions)
https://betterhealthwhileaging.net/how-to-manage-difficult-alzheimers-behaviors-without-drugs/
➢ “An approach used by clinicians that does not use medications to treat behaviors,
symptoms and disorders.”
➢ Experts recommend that non-pharmacological interventions be used as a safe first line of
treatment against challenging behaviors. One of the downsides to using non-medical
alternatives is the uncertainty of how effective they are.
➢ “​M​ost professionals have some training in medication prescription for BPSD ​and very
little are​ instructed about nonpharmacological interventions or receive information about
their effectiveness. As a consequence, antipsychotics drugs are frequently prescribed
before alternative nonpharmacological approaches are attempted, and patients are
maintained in medication for long periods, which leads to increased morbidity and
mortality.” ​Oliveria
➢ Examples:
○ Aromatherapy: ​The use of aromatic plant extracts and essential oils
○ Pet therapy: ​Animal associated therapy that is used to help people recover from
and cope with their health problems
○ Music therapy: ​The use of music to restore/ improve the physical, emotional and
physiological health of an individual
○ Art therapy: ​A form of therapy that allows individuals to engage in artistic
activities as a mean of creative expression
○ Environmental changes
○ Structured activities
○ The use of audio or video recordings of family members
➢ Environmental and social factors such as over or under stimulation, poor staff
communication skills, unskilled personal care, inappropriate routines and rough or
hurried showering or toileting are all common triggers for these behaviors
➢ “...the American Geriatric Society and the American Association for Geriatric Psychiatry
currently consider nonpharmacological interventions to be first line Clinical Practice,
except for emergency situations, referring mostly to situations in which the patient's
behavior is harmful to him/her or other persons”

(pharmacological interventions)
➢ “An approach used by clinicians that uses medications to treat behaviors, symptoms and
disorders”.
➢ Challenging behaviors are commonly treated using psychotropic medications,
particularly antipsychotics.
➢ Not FDA approved
➢ “most professionals have some training in medication prescription for BPSD, but few are
instructed about nonpharmacological interventions or receive information about their
 effectiveness. As a consequence, antipsychotics drugs are frequently prescribed before
alternative nonpharmacological approaches are attempted, and patients are maintained in
medication for long periods, which leads to increased morbidity and mortality.”
➢ “Unfortunately, the modest benefits associated with antipsychotics must be balanced
against significant safety concerns including accelerated cognitive decline, stroke, and
death, particularly when used in long term”
➢ “By consensus, the most promising future pharmacological treatments for agitation were
dextromethorphan/quinidine, with a mix of support for mirtazapine and prazosin, and a
wider range of compounds also highlighted as potential candidates in discussion”
Information not used
➢ “There is evidence to support modest symptomatic benefit of short-term treatment with
atypical antipsychotics, particularly Risperidone, Olanzapine and Aripiprazole”
Information not used
➢ Safety concerns with antipsychotics include cognitive decline, stroke and death when
used long term
➢ Many antipsychotics are prescribed “off label” since no medication is FDA approved to
treat these behaviors
➢ Problem- can be a chemical restraint”
➢ 5 types of medications can be used against Dementia: Antipsychotics, Benzodiazepines,
Mood stabilizers, Antidepressants, Dementia Drugs
➢ 1-Antipsychotics: sedating, calm aggression and agitation, can reduce delusions,
hallucinations, or paranoia
○ Risperidone, Quetiapine, Olanzapine, Haloperidol
○ The risks: decreased cognitive function, increase in fall risks, stroke, death,
extrapyramidal symptoms (tremors, stiffness)
➢ 2-Benzodiazepines: Relaxant commonly used for people who experience anxiety, panic
attacks, or insomnia
Lorazepam, Temazepam, Diazepam, Alprazolam, Clonazepam
○ Benzodiazepines cause relaxation and sometimes sedation, similar to the effects
of alcohol
○ The risks: increased risk of falls, Paradoxical agitation, increased confusion,
worsening of delirium, acceleration of cognitive decline, increased anxiety
○ “Stopping Benzodiazepines suddenly can provoke life-threatening withdrawal
symptoms, so medical supervision is mandatory when reducing this type of
medication.”
➢ 3-Mood-stabilizers: reduce “excitability” of brain cells
○ Valproic Acid
○ The risks: Worsening of confusion, dizziness, difficulty walking, Tremors
➢ 4-Antidepressants
 ○ Selective Serotonin Reuptake Inhibitors (SSRI), Mirtazapine, Trazodone
○ The risks: gastrointestinal distress, nausea, can worsen insomnia, increased
agitation, increased fall risk
➢ 5-Dementia Drugs (FDA approved)
○ Donepezil, Rivastigmine, Galantamine, Memantine
○ Cons: little cognitive improvement, makes activities of daily living manageable