Your 84-year-old patient's son is distraught. “I know Mom has dementia, but I don’t understand why she cannot relax. She is busy all night long, taking out the silverware, packing her clothes, and trying to leave the house. Sometimes she tells me that there are little children in the room. These hallucinations scare me, although they do not seem to bother her very much. She keeps me awake; I’m often late to work because I’m up much of the night. I’m afraid I’m going to lose my job; and I don’t want to put Mom into a nursing home. Please give her a medication for this behavior.”
Another of your patients, an 82-year-old man, is admitted to a nursing home after an emergency hospitalization in the geriatric psychiatry unit. His daughter left him alone with her boyfriend one morning while she went to work. Not recognizing him, your patient attacked the young man with a kitchen knife. The police initially arrested your patient and then had him admitted to the psychiatric unit. He is discharged 2 weeks later to the nursing home.
Can anything be done for these patients?
A GROWING PROBLEM
Dementia is a growing problem with the aging of the population. At the time of the 2000 census there were 4.5 million people in the United States with Alzheimer disease, the most common type of dementia, 1 and the prevalence is expected to increase to 13.2 million by the year 2050. 1
CONSERVATIVE MEASURES ARE THE MAINSTAY OF TREATMENT
As for offending drugs, removing an antimuscarinic or anticholinergic drug may resolve hallucinations; stopping propoxyphene (Darvon) may improve sleep.
No drugs are approved for treating hallucinations, agitation, or other distressing behavior in neurodegenerative diseases such as Alzheimer dementia. Rather, the mainstay of treatment is behavioral and environmental modification. 7 In an environment optimized to maximize comfort, reduce stress, and permit safe wandering, behavioral medications may be unnecessary.
Nevertheless, environments are not always optimal, and physicians may offer medications to treat behavioral symptoms to improve quality of life and to let patients keep living in the community.