When it comes to treating non-cognitive symptoms of dementia, such as behavioural changes or psychological issues, medication may be used.
However, the decision to use medications should always involve a thorough evaluation by a healthcare professional who specialises in geriatric care. They will assess the benefits and risks and carefully monitor for any side effects. They will also consider any other health conditions and medications, as they can increase the risk of medical problems and drug interactions. Possible side effects include a higher risk of heart and blood vessel issues, falls, confusion, excessive sleepiness, metabolic problems, and even death.
Non-drug treatments, such as behavioural therapy, changes to the environment, and emotional support, should also be considered as part of a comprehensive care plan.
Medication Choices and Potential Side Effects
Medications can be useful in managing certain symptoms of dementia, but they can also have side effects. The choice of medication will depend on the individual’s symptoms, overall health, and other factors. Some commonly prescribed medications include:
- Antipsychotic medications: These may be used for agitation, aggression, or psychosis. Side effects include sedation, increased risk of falls, movement disorders (such as tardive dyskinesia and parkinsonism), cardiovascular issues, and even increased risk of death in elderly patients.
- Antidepressant medications: SSRIs (selective serotonin reuptake inhibitors) and other antidepressants may be prescribed for depression, anxiety, or irritability. Possible side effects include stomach problems, sedation, sexual issues, and drug interactions.
- Anxiolytics: Medications like benzodiazepines can help with anxiety, restlessness, or sleep problems but can lead to sedation, confusion, falls, dependence, and respiratory issues.
- Mood stabilisers: These can help with mood swings and aggression. Side effects include stomach issues, weight gain, tremors, and drug interactions.
First Step
Before considering medication, ensure all non-pharmacological interventions have been explored (as outlined in this app).
Antipsychotic medication should only be considered after ruling out all other potential causes of NCSD and when non-drug treatments haven't worked. These non-pharmacological treatments should be tried first, unless there's serious distress or a clear risk of harm to the person or others, as per National Clinical Guideline No. 21.
Guidelines for Safe Medication Use
Current guidelines recommend using the least harmful medication for the shortest time. The National Clinical Guideline No. 21 provides detailed advice on prescribing psychotropic medications for non-cognitive symptoms in people with dementia.
For more details, visit the HSE website and download the algorithm for prescribing medications for NCSD.
