In a previous post on the "Psychosocial Issues and Neuropsychology" session at ICAD, I wrote about Dr. Alistair Burns' presentation on how caregiver interventions and nondrug therapies can help reduce dementia-related psychological symptoms like agitation and anxiety. During the same session, Dr. Clive Ballard, Director of Research for the Alzheimer's Society and a Professor at Kings College London Institute of Psychiatry, made the case for why we need nondrug interventions. Dr. Ballard focused on reviewing the evidence that drug treatments are often sub-optimal.
Antipsychotics are the mainstay treatment for "behavioral" symptoms of dementia, Dr. Ballard said. But when he and a colleague conducted a review of trials of these drugs, they found that the serious side effects of the drugs often outweigh any benefit. Side effects can include a doubling of the rate of cognitive decline. These side effects aren't due to a "secret pharmaceutical action," he said, but instead are the predictable effect of elderly vulnerable people being heavily sedated and inactive.
- antipsychotics may be appropriate for short term use in cases of extreme distress or extreme risk, but the potential benefits must be weighed with potential harm
- the risks generally outweigh the benefits for long term use of antipsychotics in people with dementia.
At least in the U.S., these drugs carry "black box" warnings that they are not approved for the treatment of patients with dementia-related psychosis [click here for more on this and CATIE-AD study].
If antipsychotics aren't always a good option for anxiety and agitation in people with dementia, then what about other drugs? The CALM-AD study showed a disappointing lack of benefits for these symptoms with Aricept, said Dr. Ballard. Other drugs are being studied, but so far there's not enough evidence they are effective.
He then briefly reviewed research on a few non-drug interventions:
- Swedish researchers have found that omega-3 supplementation does not seem to be very effective for neuropsychiatric symptoms (their study showed "possible effects" on certain symptoms depending on whether study participants carried the APOE4 gene)
- aromatherapy may be beneficial for agitation
- some psychological interventions appear to help, but more study is needed.
Even if there's not yet enough evidence that these nondrug treatments are effective, they are safe and appear to be useful, Dr. Ballard said, and should be made more available.