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Time is over for “one size fits all” dementia treatments. Next: How to best integrate non-pharmacologic and pharmacologic approaches

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Time to ‘just say no’ to behav­ior-calm­ing drugs for Alzheimer patients? Experts say yes (Med­ical Xpress):

Doc­tors write mil­lions of pre­scrip­tions a year for drugs to calm the behav­ior of peo­ple with Alzheimer’s dis­ease and oth­er types of demen­tia. But non-drug approach­es actu­al­ly work bet­ter, and car­ry far few­er risks, experts con­clude in a new report.

In fact, non-drug approach­es should be the first choice for treat­ing demen­tia patients’ com­mon symp­toms such as irri­tabil­i­ty, agi­ta­tion, depres­sion, anx­i­ety, sleep prob­lems, aggres­sion, apa­thy and delu­sions, say the researchers in a paper just pub­lished by the British Med­ical Jour­nal.

The researchers…reviewed two decades’ worth of research to reach their con­clu­sions about drugs like antipsy­chotics and anti­de­pres­sants, and non-drug approach­es that help care­givers address behav­ioral issues in demen­tia patients…“The issue and the chal­lenge is that our health care sys­tem has not incen­tivized train­ing in alter­na­tives to drug use, and there is lit­tle to no reim­burse­ment for care­giv­er-based meth­ods.”

Study: Assess­ment and man­age­ment of behav­ioral and psy­cho­log­i­cal symp­toms of demen­tia (British Med­ical Jour­nal)

  • Abstract: Behav­ioral and psy­cho­log­i­cal symp­toms of demen­tia include agi­ta­tion, depres­sion, apa­thy, repet­i­tive ques­tion­ing, psy­chosis, aggres­sion, sleep prob­lems, wan­der­ing, and a vari­ety of inap­pro­pri­ate behav­iors. One or more of these symp­toms will affect near­ly all peo­ple with demen­tia over the course of their ill­ness. These symp­toms are among the most com­plex, stress­ful, and cost­ly aspects of care, and they lead to a myr­i­ad of poor patient health out­comes, health­care prob­lems, and income loss for fam­i­ly care givers. The caus­es include neu­ro­bi­o­log­i­cal­ly relat­ed dis­ease fac­tors; unmet needs; care giv­er fac­tors; envi­ron­men­tal trig­gers; and inter­ac­tions of indi­vid­ual, care giv­er, and envi­ron­men­tal fac­tors. The com­plex­i­ty of these symp­toms means that there is no “one size fits all solu­tion,” and approach­es tai­lored to the patient and the care giv­er are need­ed. Non-phar­ma­co­log­ic approach­es should be used first line, although sev­er­al excep­tions are dis­cussed. Non-phar­ma­co­log­ic approach­es with the strongest evi­dence base involve fam­i­ly care giv­er inter­ven­tions. Regard­ing phar­ma­co­log­ic treat­ments, antipsy­chotics have the strongest evi­dence base, although the risk to ben­e­fit ratio is a con­cern. An approach to inte­grat­ing non-phar­ma­co­log­ic and phar­ma­co­log­ic treat­ments is described. Final­ly, the par­a­digm shift need­ed to ful­ly insti­tute tai­lored treat­ments for peo­ple and fam­i­lies deal­ing with these symp­toms in the com­mu­ni­ty is dis­cussed.

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