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Antipsychotic drugs should never be used to sedate or restrain patients with Alzheimer's
disease or any other type of dementia. n fact, there are government warnings and
guidance that state antipsychotic drugs should only be used with dementia patients
when their behavioral symptoms are due to mania or psychosis
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, the symptoms present
a danger to the patient or others
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, or the individual is experiencing inconsolable or
persistent distress, a significant decline in function or substantial difficulty receiving
needed care
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. On occasion, physicians may also prescribe a seizure medication/mood
stabilizer such as Tegretol (carbamazepine) or Depakote (divalproex) for agitation.
There is an Alzheimer's vaccine that is also being studied however, due to unwanted
side effects; the clinical trial has been stopped until the vaccine can be modified to
improve the safety.
Just as drug treatments may work best on a specific category of symptoms, non-
drug treatments too may be more effective on different categories of symptoms. Most
experts feel that non-drug approaches should always be tried prior to drug treatments.
While cognitive symptoms are typically treated with medications, some therapies such
as cognitive stimulation have started to gain momentum, especially in recent
international studies. Some examples of cognitive stimulating activities are trivia
games, poetry reading, storytelling, reminiscing, word games, puzzles with large pieces,
bingo using limited numbers or pictures, crossword puzzles or 'name that tune'. The
following are suggestions to keep in mind when attempting cognitive stimulating
programs: provide activities that encourage, not frustrate the individual, allow time to
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respond, ensure activities are not too difficult or too elementary as both can cause
agitation or behavior problems and cognitive programs are more successful when done
in smaller groups. Reminiscing activities can have a profound value, by focusing on
reminiscing and using suitable cues and prompts, caregivers can enhance the
individual's feeling of self worth, it can validate his/her contributions and feelings.
Non-drug treatment of behavioral symptoms begin with analyzing the behavior,
identifying what may have caused it and creating an approach that either changes the
person's environment or the caregiver's reaction to the behavior. Everyone who
develops behavioral symptoms should receive a medical examination, especially if the
symptoms suddenly appear. Typically the primary cause of behavior problems is the
effect of Alzheimer's disease but sometimes an exam will reveal that something as
simple as a common illness or drug side effect is the culprit. Environmental factors can
also contribute to behavioral symptoms. Events or changes is the surroundings of an
Alzheimer's patient may create a sense of uneasiness or increase fear and confusion.
Some potential solutions are monitoring the individual's personal comfort, check for
pain, hunger, full bladder, fatigue, infections and skin irritations; avoid being
confrontational or arguing, instead respond to the feelings behind what is being
expressed; redirect the person's attention, remain flexible, patient and supportive;
create a calm environment, avoid noise, glare and too much background distraction and
finally, simplify the environment, tasks and solutions. Although there are no long term
effects, music therapy is another way to improve behavior and social interaction
sometimes results in improvement in psychosocial symptoms in some individuals.
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Snoezelen therapy is another treatment that aids in eliminating behavior
symptoms. Snoezelen is a combination of two Dutch verbs: snuffelen which means to
seek out, sniff or explore and doezelen which means to relax
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. Snoezelen was
developed in the late 1970s by two Dutch therapists, at the time, it was considered to be
radical, and today it is a common practice. t is based on the idea that symptoms such
as anxiety and agitation might result from periods of sensory deprivation, it was
originally used for autistic children but quickly became an accepted therapy for
dementia patients. Snoezelen is an environment filled with lights, sounds, textures and
aromas used to stimulate, calm, relax or energize the individual. t is usually set up in a
designated room and can be staged to provide a multisensory experience or a single-
sensory experience. A Snoezelen environment is safe, non-threatening and has been
proven effective with long term care residents who have been diagnosed with dementia
as well as other injuries or diseases. Reports on Snoezelen environments document
accounts of residents who have stopped self abusive behavior; of people who have
'seen' (become aware of the physical environment); spoken or smiled for the first time in
years; and of those who have showed unusual (for them) peace, happiness and
contentment
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.
Yet another important aspect of Alzheimer's treatment has to do with the
environment whether it's in a facility or in the private home. Environmental
modifications are known to improve day to day functioning in people with Alzheimer's.
Some examples of environmental modifications in a long term care facility would be to
build a round structure, often, individuals with Alzheimer's tend to pace or walk, if the
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structure is circular, it creates an environment with no blind alleys and provides self
queuing; there should be private rooms that open to a central family/great room; there
should be a secure outdoor area to protect patients who wander or exit seek and the
facility should have landmarks differentiated by color or shape to assist with queuing.
Home modifications are primarily safety modifications however, there are a number of
specific modifications have been shown to be beneficial in reducing problem behavior:
O Low levels of light during meals may improve eating habits
O Simply furnished spaces with little or no clutter minimize distractions
O Consistent background noise, music or simulated nature sounds
O Place objects that cue memories in clear view
O Ensure privacy and personal space
Researchers are still investigating which modifications are most beneficial.
The final treatments to discuss are alternative treatments. There are a growing
number of herbal remedies, vitamins and other dietary supplements that are promoted
as memory enhancers or Alzheimer's treatments. Because FDA approval is not
required for dietary supplements, the effectiveness of these products are primarily
based on testimonials. There are of course concerns about these treatments because
the effectiveness and safety are unknown, the purity is unknown, adverse reactions are
not routinely monitored and dietary supplements can have serious side effects with
prescription medications. The supplements being touted as Alzheimer's treatments are
Coenzyme Q10, an antioxidant, Coral Calcium, Ginkgo Biloba which has been shown to
have no benefit in treating Alzheimer's, Huperzine A which is a moss extract and has
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been used in Chinese medicine for centuries, Omega-3 fatty acid, research has linked a
high intake of Omega-3 to a possible reduction in risk of dementia and
Phosphatidylserine, a kind of lipid that is thought to shore up the cell membrane and
possibly protect cells from degenerating.
n closing, despite the efforts of some of the world's best researchers and
regardless of the treatment, Alzheimer's is a devastating disease with no cure at this
time. With the generation of baby boomers entering the ranks of our senior population it
will only become more devastating unless a cure is discovered. Until that time, it is
important to remember, that it only takes one word or action to trigger what seemed like
a long lost memory and bring your loved one back if only for a moment.
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