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About Dementia:
➢ Dementia is a broad term used to describe various symptoms that can be caused
by disorders of the brain. A person who suffers from dementia typically loses
their ability to control their emotions, solve problems and maintain their behavior.
A common symptom is the loss of memory, however doctors do not specifically
use memory loss to diagnose an individual with dementia unless two or more
brain functions are affected.
➢ Diseases that can cause symptoms of dementia:
○ Alzheimer’s Disease:
○ Vascular dementia: caused by a series of small strokes. 2nd most common
cause of Dementia
○ Lewy Body Dementia: Begins between the ages of 50 and 85. Happens
when abnormal structures, called Lewy Bodies, build up in areas of the
brain. No cure for this however treatments are used to reduce symptoms.
○ Frontotemporal Dementia: Describes a clinical syndrome associated with
shrinking of the frontal and temporal lobes. This results in changes of
behavior or problems with language
○ Huntington’s disease: Causes nerve cells in your brain and spinal cord to
deteriorate. Symptoms usually appear in your 30s or 40s
○ Creutzfeldt-Jakob disease: A rare brain disorder that can be inherited or
generated from exposure to diseased brain or nervous system tissue. This
condition is fatal and symptoms usually appear around the age of 60
○ Parkinson's Disease: A clinical diagnosis related to Lewy Body Dementia.
This affects a person’s memory, social judgement, language and
reasoning.
➢ Other conditions that can cause dementia-like symptoms:
○ Brain tumors
○ Anoxia or hypoxia
○ Endocrine abnormalities
○ Nutritional deficiencies
○ infections
➢ NOT A PART OF THE NORMAL AGING PROCESS
About BPSD:
Possible video?

(non-pharmacological interventions)
https://betterhealthwhileaging.net/how-to-manage-difficult-alzheimers-behaviors-without-drugs/
 ➢ Experts recommend that non-pharmacological interventions be used as a safe first line of
treatment against challenging behaviors. One of the downsides to using non-medical
alternatives is the uncertainty of how effective they are.
➢ “most professionals have some training in medication prescription for BPSD, but few are
instructed about nonpharmacological interventions or receive information about their
effectiveness. As a consequence, antipsychotics drugs are frequently prescribed before
alternative nonpharmacological approaches are attempted, and patients are maintained in
medication for long periods, which leads to increased morbidity and mortality.”
➢ Examples:
○ Aromatherapy
○ Pet therapy
○ Music or white noise therapy
○ Bright light therapy
○ Environmental changes
○ Structured activities
○ The use of audio or video recordings of family members
➢ Environmental and social factors such as over or under stimulation, poor staff
communication skills, unskilled personal care, inappropriate routines and rough or
hurried showering or toileting are all common triggers for these behaviors
➢ “...the American Geriatric Society and the American Association for Geriatric Psychiatry
currently consider nonpharmacological interventions to be first line Clinical Practice,
except for emergency situations, referring mostly to situations in which the patient's
behavior is harmful to him/her or other persons”

(pharmacological interventions)
➢ Challenging behaviors are commonly treated using psychotropic medications,
particularly antipsychotics.
➢ Not FDA approved
➢ “most professionals have some training in medication prescription for BPSD, but few are
instructed about nonpharmacological interventions or receive information about their
effectiveness. As a consequence, antipsychotics drugs are frequently prescribed before
alternative nonpharmacological approaches are attempted, and patients are maintained in
medication for long periods, which leads to increased morbidity and mortality.”
➢ “Unfortunately, the modest benefits associated with antipsychotics must be balanced
against significant safety concerns including accelerated cognitive decline, stroke, and
death, particularly when used in long term”
➢ “By consensus, the most promising future pharmacological treatments for agitation were
dextromethorphan/quinidine, with a mix of support for mirtazapine and prazosin, and a
wider range of compounds also highlighted as potential candidates in discussion”
➢ “There is evidence to support modest symptomatic benefit of short-term treatment with
atypical antipsychotics, particularly Risperidone, Olanzapine and Aripiprazole”
➢ Safety concerns with antipsychotics include cognitive decline, stroke and death when
used long term
➢ Many antipsychotics are prescribed “off label” since no medication is FDA approved to
treat these behaviors
➢ Problem- can be a chemical restraint”
➢ 5 types of medications can be used against Dementia: Antipsychotics, Benzodiazepines,
Mood stabilizers, Antidepressants, Dementia Drugs
➢ 1-Antipsychotics: sedating, calm aggression and agitation, can reduce delusions,
hallucinations, or paranoia
○ Risperidone, Quetiapine, Olanzapine, Haloperidol
○ The risks: decreased cognitive function, increase in fall risks, stroke, death,
extrapyramidal symptoms (tremors, stiffness)
➢ 2-Benzodiazepines: Relaxant commonly used for people who experience anxiety, panic
attacks, or insomnia
Lorazepam, Temazepam, Diazepam, Alprazolam, Clonazepam
○ Benzodiazepines cause relaxation and sometimes sedation, similar to the effects
of alcohol
○ The risks: increased risk of falls, Paradoxical agitation, increased confusion,
worsening of delirium, acceleration of cognitive decline, increased anxiety
○ “Stopping Benzodiazepines suddenly can provoke life-threatening withdrawal
symptoms, so medical supervision is mandatory when reducing this type of
medication.”
➢ 3-Mood-stabilizers: reduce “excitability” of brain cells
○ Valproic Acid
○ The risks: Worsening of confusion, dizziness, difficulty walking, Tremors
➢ 4-Antidepressants
○ Selective Serotonin Reuptake Inhibitors (SSRI), Mirtazapine, Trazodone
○ The risks: gastrointestinal distress, nausea, can worsen insomnia, increased
agitation, increased fall risk
➢ 5-Dementia Drugs (FDA approved)
○ Donepezil, Rivastigmine, Galantamine, Memantine
○ Cons: little cognitive improvement, makes activities of daily living manageable