Drugs used to relieve behavioural and psychological symptoms in dementia
People with dementia may develop behavioural and psychological symptoms including restlessness, aggression, delusions, hallucinations, apathy and sleep disturbances. This factsheet looks at the different types of drugs that can be used to treat these symptoms if non-drug treatments have not worked. It explains when and how they should be prescribed and what the side-effects might be. Other psychological symptoms that people with dementia may develop include depression and anxiety. For information about these symptoms and how they can be treated, see factsheet 444, Depression and anxiety.
Behavioural and psychological symptoms in dementia
Behavioural and psychological symptoms in dementia are very common and usually develop as the disease progresses. These symptoms can be distressing, both for the person themselves and the carer. For example delusions (believing things that are not true, such as that the carer is an impostor) may cause the person to feel angry and behave in a hostile way. Hallucinations (seeing or hearing things that aren’t there, such as hearing voices) might make the person feel afraid. 1
If a person with dementia develops behavioural and psychological symptoms it is important to remember that they are not ‘behaving badly’ and are not to blame. The symptoms may be a direct result of changes in the chemicals of their brain, or be due to a general health problem, such as discomfort caused by hunger, thirst or infection. These symptoms can also be related to the care a person is receiving, their environment or social interactions. There are a number of different ways that behavioural and psychological symptoms in dementia can be relieved. This factsheet explains the different types of drugs that can be used. It is, however, important to note that most behavioural and psychological symptoms improve within four weeks without the need for medication.
When should drugs be used to treat behavioural and psychological symptoms in dementia?
Before medication is considered, any person with dementia who develops behavioural and psychological symptoms should be offered an assessment by their GP at an early opportunity. This assessment should try to establish any possible underlying factors that may have triggered or may be aggravating the person’s symptoms. It is important to ensure that the person with dementia is physically healthy, comfortable and well cared for. The person should also be helped to lead an active life, with interesting and stimulating daily activities. In this way it is often possible to avoid the use of drugs altogether. Simple non-drug treatments, such as reminiscence therapy and social interaction, can also prevent the need for drugs. For example, research suggests that some symptoms can be reduced by just 10 minutes of one-to-one time each day. A recent study also demonstrated that recognising and treating pain can significantly reduce agitation and aggression in people with dementia. Other examples of treatments include aromatherapy, talking therapies, animal therapy, music and dance therapy and massage. According to guidance from the National Institute for Health and Clinical Excellence (NICE), nondrug treatments such as these should be used before medication is 2
prescribed – unless the person with dementia or others are at risk of severe harm. If these approaches do not help the person and their symptoms are severe or distressing, medication may be necessary.
Drug treatments – general information
All drugs have at least two names: a generic name, which identifies the substance and a proprietary (trade) name, which may vary depending upon the company that manufactured it. (For example, Aricept is the trade name for the anti-Alzheimer’s drug donepezil hydrochloride.) This factsheet uses generic names. Immediate results should not be expected in people taking drugs for behavioural and