Medications & Dementia
It is generally a good idea to try nondrug interventions before turning to medications, but sometimes medications are necessary.

Medications for behavioral symptoms should be started at a low dose and then increased slowly based on the patient’s response and the presence of side effects. Certain types of medications may actually increase confusion, and people with cognitive problems may be particularly sensitive to these effects. In addition, they may interfere with the medications used to treat cognitive problems.

Anxiety

What medications are commonly used for anxiety?
The class of drugs includes things like valium and is referred to as benzodiazepines. Unfortunately, in older adults, these medicines often cause more confusion and falls.

Can other interventions be used?
Nondrug alternatives to cope with anxiety include relaxation techniques, meditation and physical activity.

Are there other drug alternatives to these class of medications?
Currently, the selective serotonin reuptake inhibitors (SSRIs) that are typically used for depression have been demonstrated to be helpful in managing anxiety. Some examples include citalopram (Celexa®) or escitalopram (Lexapro®).

Incontinence

What medications are commonly used for incontinence?
The most common drug used for incontinence is oxybutynin (Ditropan®) which may, unfortunately, worsen the chemical imbalance that is common in memory problems and counteract the effects of most memory medicines.

Can other interventions be used?
Avoiding the intake of bladder irritants with caffeine, such as coffee or chocolate is recommended. Regular, timed trips to the restroom may avoid the bladder becoming too full and accidents.

Are there other drug alternatives to this medication?
Being sure of the cause of the incontinence is important as this medication does not usually help with incontinence due to prostate enlargement, and there are effective medications for that condition which do not affect thinking or memory.

Insomnia

What medications are commonly used for sleep?
Many over the counter medications have diphenhydramine (Tylenol PM®, Advil PM®, Benadryl®) which can worsen the chemical imbalance common in memory problems and cause significant confusion and a risk of falls. It may also counteract the effects of memory medicines. Ambien is a prescription medication that may also increase confusion and the risk of falls.

Can other interventions be used?
Soothing nighttime routines, including warm baths or warm milk, may be helpful. Avoiding food or drinks with caffeine late in the day. Being active and avoiding daytime napping can help in promoting sleep. Exposure to bright light during the day and darkness at night has also been demonstrated to be helpful.

Are there any other drug alternatives to this medication?
Melatonin is an over the counter supplement that has been shown to be effective in helping people get to sleep with minimal side effects. Trazodone is a prescription medication, initially studied as an antidepressant which is often used for sleep in the elderly due to low risk of side effects.

Depression

What medications are commonly used for depression?
Currently, the SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed medications for mood symptoms. SSRIs may be useful in reducing the aggressive impulses, poor impulse control and carbohydrate craving seen in some people with dementia. However, paroxetine and nortriptyline are two other common antidepressants which may worsen the cholinergic imbalance in the brain and interfere with the effectiveness of memory medicines.

Examples of SSRIs include:

  • fluoxetine (Prozac®)
  • sertraline (Zoloft®)
  • paroxetine (Paxil®)
  • fluvoxamine (Luvox®)
  • citalopram (Celexa®)
  • escitalopram (Lexapro®)

Other antidepressants (not SSRIs) that may be useful:

  • trazodone (Desyrel®)
  • venlafaxine (Effexor®)
  • duloxetine (Cymbalta®)
  • bupropion (Wellbutrin®)
  • mirtazepine (Remeron®)

Can other interventions be used?
Physical activity is often helpful in counteracting mood symptoms. Therapy and counseling can be helpful in supporting an individual with depressive symptoms.

Are there any other drug alternatives to this medication?
The newer class of SSRIs do not have these side effects and can be used safely.

Pain

What medications are commonly used to treat pain?
Narcotics and opiates such as hydrocodone (Vicodin®) or oxycodone (OxyContin®) are often used for pain relief. Unfortunately, they often can cause confusion and falls in older adults.

Can other interventions be used?
Meditation has been found to be helpful in coping with pain, especially more chronic situations. Local therapy (heat, ointments) do not usually have the systemic effect on cognition and thinking.

Are there any other drug alternatives to this medication?
Regular around the clock use of Tylenol® can be very helpful in controlling pain with minimal side effects. Significant alcohol history or any decrease in liver function must be considered in determining dosage and length of therapy.

Hallucinations & Delusions

What medications are commonly used for hallucinations and delusions?
Antipsychotic medications block the effects of dopamine, a chemical messenger in your brain that can increase hallucinations and delusions (false beliefs) and can alter rational thought. Low doses of these medications can help manage aggressive, irrational and compulsive behaviors that may develop with frontotemporal dementia or dementia with Lewy bodies. The potential benefit of antipsychotics must be weighed against potential risks including weight gain, slowing of movement and thinking, accelerating heart disease and, in rare instances, death. Typical antipsychotics are associated with muscle problems and should be avoided in people who already experience muscle stiffness or trembling.

Examples of atypical antipsychotic medications include:

  • olanzepine (Zyprexa®)
  • quetiapine (Seroquel® or Ketipinor®)
  • risperidone (Risperdal®)
  • ziprasidone (Geodon®)
  • aripiprazole (Abilify®)
  • paliperidone (INVEGA®)

Other classes of drugs that might be useful, but have not been studied in Pick’s/FTD are anti-anxiety drugs and anti-seizure medications used as “mood stabilizers.”

  • valproic acid and divalproex sodium (Depacon™, Depakene®, Depakote®, Depakote® ER)
  • carbamazepine (Tegretol®)
  • gabapentin (Neurontin®)

Medication Resources

Complementary & Alternative Medicine

Practitioners of complementary and alternative medicine (CAM) use health care practices and products that are not considered a part of the conventional medicine practiced by holders of medical, osteopathy, nursing and therapy degrees. The list of treatments considered CAM evolves regularly with new research. It is important to remember herbal and alternative treatments may interact with prescribed or nonprescription medications, and as with all treatments, possess the potential for side effects. Herbs are typically used in combination with each other and usually do not have serious side effects when used appropriately at suggested doses. It is not unusual for an individual to use complementary medicine and conventional medicine at the same time.

The Risks of Herbal Treatments

Many people feel that traditional herbal products are more “natural” and safer than conventional drugs. Unfortunately, unlike prescription and over-the-counter medications, most herbal products are considered “dietary supplements” and do not need to be proven safe or effective before they are sold. Herbs are essentially crude drugs with the potential for both beneficial and harmful effects.

Herbal products or very high doses of vitamins or minerals can have dangerous drug interactions and side effects, just like prescription and other nonprescription products. Side effects may reflect the purity of the preparation or additives. Stop taking herbal products and contact your health care provider immediately if side effects, a rash, or signs of an allergic reaction occur.

In some cases, the herbal content of a product is considerably more or less than the strength listed on the label. While most herbal products are safe, some products have been found to contain pesticides, heavy metals, toxic herbs or prescription medications. For this reason, it is recommended that only high-quality products be used.

Be safe. Talk with your doctor earlier rather than later. Your doctor can help determine if there are any dangerous side effects or drug interactions and help determine the right dosage for you. As with all medications, more is not better and can lead to serious illness and death.

Selecting Herbal Treatments

If you are considering an herbal treatment, here are a few questions you should ask first:

  • Is the product manufactured in the United States?
  • Is the manufacturer well known and reputable? (Ask your pharmacist)
  • Does the label list the name and form of the herb(s), the amount of the herb(s) in each dose in milligrams or grams, a lot number, and an expiration date? If you choose to use products brought in from other countries, read the label carefully with your pharmacist. Watch out for names of prescription drugs such as ephedrine and phenobarbital, which have been found in herbal products.
  • Does the label or product information list a toll-free number you can call for more information?
  • Call and ask how the raw herbs are accurately identified and how the product is tested for purity and potency. Some manufacturers will send a copy of their analysis to you and/or your physician, nurse or pharmacist. An independent laboratory (ConsumerLab.com) has tested some herbal products for purity and potency. Check their website and select an approved product or a manufacturer that clearly provides quality control.
  • Have you discussed the possible benefits and adverse effects of the product with your pharmacist and/or physician?

Ingredients to Avoid

  • Heavy Metals: Excessive amounts of arsenic, lead and mercury have been found in some herbal products. Some, but not all, herbal product manufacturers have their raw herbs tested for heavy metal content.
  • Prescription Drugs: Prescription drugs such as phenobarbital, ephedrine, chlorpheniramine, non-steroidal anti-inflammatory drugs, benzodiazepines, corticosteroids and methyltestosterone have been found in some herbal products, most often those manufactured overseas.
  • Misidentified Herbs: The fact that some herbs can cause serious toxicity is well documented. The identification of raw herbs is traditionally made on the basis of appearance, taste, smell and feel. This may not be sufficient when the desired herb closely resembles a toxic botanical. In these instances, chemical analysis is required.

CAM Resources