Pharmacological versus non-pharmacological approaches to managing challenging behaviours for people with dementia

Abstract

When people with dementia demonstrate challenging behavioural and psychological symptoms of dementia, the levels of stress experienced by their carers increases. Furthermore, there is an increased likelihood that the person will be prematurely admitted to a residential care facility. The adverse side-effects that have been associated with the use of antipsychotic medications in older people with dementia have given rise to a renewed emphasis on the use of non-pharmacological approaches to manage challenging behaviours. This article describes the approaches taken by the multi-disciplinary team of a Dementia Behaviour Management Advisory Service in Australia to support people with dementia who have challenging behaviours by using non-pharmacological interventions.

Exploring psychosocial interventions for people with dementia that enhance personhood and relate to legacy- an integrative review

“…This has had negative outcomes [ 10 , 13 ]. Associated side effects of antipsychotic medications have been described as adverse [ 14 ] and particular medication has been found to be ineffective for certain aspects of dementia, such as agitation [ 12 ].…”

Addressing Adventitious Behaviors Associated with Dementia

“…While pharmacological interventions are undoubtedly needed in some cases, the benefit of decreasing the risk of serious adverse drug effects is noted related to the use of nonpharmacological interventions [8]. A complementary pharmacological intervention would include frequent medication reviews to reduce the administration of unnecessary and inappropriate medications [9]. Following occupational therapy recommendations regarding environmental modalities has been shown to diminish episodes of agitated behaviors [10].…”

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“…Preliminary results from small studies offer conservative benefits for the use of antiepileptic agents to decrease behavioral disturbances, with some agents showing little to no effect in addressing those behaviors (Hungerford et al 2014). A small number of studies have modestly supported carbamazepine, gabapentin, topiramate and lamotrigine in managing agitation and aggression in some patients, whereas valproate and lithium provided very limited or no effectiveness in managing behaviors (Yeh and Ouyang 2012, Amann et al 2009, Ng et al 2009, Desai and Grossberg 2001.…”

“…For instance, neuron damage now is believed to be a rather continuous and ongoing process caused from tangles (Anand et al 2014). A complex casqued of mechanisms affecting mitochondrial dysfunction, and contributing to chronic oxidative stress, inflammation, hormonal imbalances, neurofibrillary tangle accumulation, in addition to genetic abnormalities, seem to have a significant contribution in the disease process (Hungerford et al 2014). Currently, the focus of pharmacological and non-pharmacological treatments is on addressing specific symptomatology.…”