Antipsychotics For Dementia

Our uncle has Alzheimer’s Dementia and is on quetiapine [Seroquel] to control his agitation. The nursing home wants to stop that drug.  If it keeps his behavior controlled, why do we have to stop?

This drug is one of several anti-psychotics [such as risperidone [Risperdal], olanzapine [Zyprexa], haloperidol [Haldol] that are NOT approved by the FDA for use in dementia; rather, they were intended for disorders like schizophrenia.  Most dementia patients will have times of agitation; staff have difficulty managing these behaviors and naturally turn to a ‘quick fix’– everyone wants “a pill for every ill”!

These drugs have a lot of side-effects and fail to improve the quality of living for most seniors – patients are essentially just sedated so they don’t bother others.

Although some dementia patients truly have hallucinations or delusions [seeing or believing things that aren’t real] which interfere with their life quality and can benefit from anti-psychotics, evidence is accumulating that we must take a different approach when treating these residents.

For example, pain is a common, unrecognized issue; dementia patients have trouble describing or coping with it; if you treat them with a pain medicine, they often feel better, which improves their behavior!

Non-pharmaceutical approaches also help and nursing homes are expected to try these first: lavender aromatherapy is a good example that has worked for many. 
Because of the problems associated with these drugs, Medicare, with the support of medical societies, expects nursing homes to decrease their use:  next year, they are must reduce the number of residents taking anti-psychotics by 30%.

The two nursing homes I’m with are ahead of this mandate and our residents are better for it! So, based on the evidence (and the law), I encourage families to support their facility’s efforts to reduce the drug.