9 Medication

This section looks at 2 different groups of medications that are sometimes prescribed for people with dementia.

1. ACIs (acetylcholinesterase inhibitors)

There is currently no cure for dementia but some drug treatments have been developed that can help to improve the symptoms of Alzheimers Disease. The drugs may slow down the progression of symptoms, delaying deterioration in some people.

The drugs used to treat Alzheimer’s disease have several ‘trade’ names and are collectively known as acetylcholinesterase inhibitors (ACIs).

Medication

Medication

Their individual names are:

  • Aricept (donepezil hydrochloride),
  • Exelon (rivastigmine)
  • Reminyl (galantamine)

As well as ACI’s, a new drug has been developed called Ebixa (memantine) and it works in a different way to the three drugs above.

Further learning
Alzheimer’s Society has produced a useful factsheet on drug treatments and Alzheimer’s disease http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=147

2. Anti-psychotics

We have discussed how a person with dementia may experience difficulties such as,

  • feeling restless
  • feeling angry
  • delusions and / or hallucinations.

It is very important to try to understand the reasons for these feelings and behaviours and to offer psychological interventions as discussed throughout this workbook.

If these difficulties are not responsive to person centred approaches and are causing severe distress to the person with dementia or posing significant risk to the person, it may be necessary to refer to a health professional who can consider the need for medication. One of the types of drugs which may be prescribed (if considered that the benefits will outweigh any side effects) are called ‘antipsychotics’.

Examples of anti –psychotic medications are,

  • Haloperidol (Haldol, Serenace)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal).

Anti-psychotic medication should be avoided unless it is absolutely necessary as side-effects from these types of drugs can include,

  • drowsiness,
  • dizziness and/or the person being unsteady,
  • stiffness of the limbs (which can resemble Parkinson’s disease)
  • risks of stroke for some people, particularly after being on medication for longer periods.

If antipsychotic medication is prescribed, it is essential that:

  • the minimum correct dose is prescribed and
  • a review date set, in line with local prescribing protocols.

The person with dementia must be monitored regularly for side-effects as these can have a negative impact on their quality of life. Where side effects are causing harm to the person, the medication should be reviewed urgently. For people with Lewy Body dementia it is recognised that antipsychotics may be particularly dangerous.

It is important to involve a person’s relatives in the decision to provide medication where the person is unable to consent to the treatment.

Some recent research suggests that suggest that antipsychotics may cause a person with dementia to decline at a faster rate (Ballard et al 2005, Schneider et al 2006), which alongside the risk of side effects highlights the need always to seek alternatives.

Task 5: Mr White is restless and walking around in the evenings. Think back to all the knowledge from the workbook that you have covered.

In your notebook write down what alternatives would you explore before considering the use of antipsychotic medication.

Further Learning
Alternatives to using medication are sometimes described as non- pharmacological interventions for people with dementia. There are a number of documents describing these. For example, the Alzheimer’s Society report on non-pharmacological therapies at http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=271

Further learning resources «