Antipsychotic medications are meant to treat psychosis, not dementia. Dementia care pioneer Dr. Allen Power explains:
“What happens in the brain chemically–even when people are labeled “delusional”–is not the same in diseases that cause dementia as in classical psychosis where dopamine activity is increased, causing hallucinations and delusions. The primary action [of antipsychotics] in that disorder is achieved by blocking dopamine activity.
But no form of dementia involves heightened dopamine activity; in fact many people, including those with Lewy body dementia, have decreased dopamine activity. So dopamine-blocking drugs not only have no chemical rationale, they also are particularly toxic for such people.”
The responsive behaviour sometimes expressed by people who live with dementia is more often than not the same kind of behaviour most people who don’t have dementia would express under similar circumstances. If you don’t believe me, take this four-minute survey and see for yourself.
Not only are antipsychotics unwarranted for the behavioural expressions listed below, they are ineffective in changing the behaviour for the reason stated above. In fact, they may exacerbate the behaviour they are being inappropriately given to treat (see the side effects for Seroquel/quetiapine and Risperdal/risperidone for example). Furthermore, administering these medications results in sedation that makes it virtually impossible to find and address the real cause(s) of the behaviour.
Here is a list of behavioural expressions for which antipsychotics SHOULD NOT be prescribed for people who live with dementia because they are largely ineffective in treating the root causes:
- try to get out or away from wherever they are (note: often labeled as “wandering,” “exit seeking,” “elopement,” and other such terms)
- decline help others may think they need (note: labeled as “resists care,” or “refuses care”)
- go into places or try to go into places other people think they shouldn’t go (e.g. other residents’ rooms in institutions, locked rooms, private spaces, etc.; note: also often labeled as “wandering“)
- mistake things for other things (e.g. think the TV remote is a telephone, that things that are not food are food, etc.)
- use things in ways they are not intended to be used (e.g. put a wet towel in the microwave to dry it)
- become unhappy or moody
- see or hear things differently than others do and are not frightened by their differing perceptions (e.g. think shadows on the wall are people; note: may be called “hallucinations”)
- get angry from time to time (as opposed to continuously flying into violent rages for no apparent reason)
- not want to do things other people believe are “for their own good” (e.g. take medication, have a bath or shower, go to sleep, get up in the morning, eat what is put in front of them, change their clothes, etc. note: also often labeled as “resists care,” or “refuses care”)
- believe things that are untrue (e.g. that a dead spouse, parent, friend, etc. is still alive even though they are long gone; note: these kinds of beliefs may sometimes be called “delusions”)
- become mildly or moderately anxious
- hoard or hide things
- call out, scream, yell, or verbalize repeatedly in other ways
- make noises such as clapping and tapping
- be unable to sit still
- want to stand up or walk
- go to the bathroom in public and/or other inappropriate places (sometimes described as “voiding at will”)
- take their clothes off in public
- eat things that aren’t food (see 4 above)
- curse and/or say socially inappropriate things that others may experience as being insulting or hurtful
This list is based on an excellent article by Dr. Allen Power (which also addresses the small number of situations in which the use of antipsychotics may be helpful), and a concise, practical, bullet-point fact sheet produced by Alberta Health Services as part of their Appropriate Use of Antipsychotics (AUA) Toolkit.
Dr. Power is the author of Dementia Beyond Drugs: Changing the Culture of Care and Dementia Beyond Disease: Enhancing Well-Being, both of which I highly recommend. He is also the Schlegal Chair in Aging and Dementia Innovation at the Research Institute for Aging.
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