What Medications Can Help Manage Behavioral Symptoms?

Reviewed by: HU Medical Review Board | Last reviewed: June 2022. | Last updated: July 2022

Although cognitive impairments are the main issue in Alzheimer’s disease, there are other symptoms that may arise that are just as important to address. Managing behavioral symptoms not only eases symptoms for the individual, but it also makes a difference in relationships with family members and makes caregiving easier as well.

Symptoms commonly seen in those with Alzheimer’s can include anxiety, aggression or agitation, paranoia, hallucinations, restlessness, wandering, sleeplessness, apathy, and depression.1 These behavioral changes and symptoms arise because of the progressive deterioration of normal brain cells.2 The symptoms can be challenging and upsetting and should be addressed and treated if necessary, for the benefit of the patient, their family, and their caregiver.

Medication is often not the first line of treatment for some of these symptoms, especially because of the side effects that can impair cognition or increase fall risk. Sometimes small changes like removing or modifying triggering situations or using behavioral therapies can help to ease any behavioral symptoms, but if nothing is effective or troubling behavior worsens, medication may be necessary.

Types of medications to treat behavioral symptoms

Different types of medications may be used to treat behavioral symptoms of Alzheimer’s disease, depending on what the main behaviors are. In early Alzheimer’s, behavioral symptoms tend to be things like irritability, anxiety, or depression.2 As the disease progresses and more brain cells are destroyed, symptoms worsen and can include aggression, anger, restlessness, hallucinations and/or delusion, physical or verbal outbursts, and sleep disturbances.2

Medications typically used for behavioral symptoms in Alzheimer’s can include antidepressants, anxiolytics, and antipsychotics.

Antidepressants help to address depressive symptoms, irritability, and mood changes; anxiolytics can help treat anxiety, agitation, and resistance; and antipsychotics treat hallucinations and delusions, aggression, agitation, and hostility.2 These medications are to be used thoughtfully and cautiously, as they carry significant side effects and can interact with other medications the patient might be taking. These drugs can also make cognitive symptoms worse.

People over the age of 65 may also be more sensitive to the effects and adverse events caused by these medications. That is why it is critical to see a neurologist that specializes in memory disorders and or a geriatrician.

Prior to being prescribed any of these drugs, the doctor will do a thorough examination of the patient and discuss the severity and duration of the symptoms and what has already been done to help address the behaviors. They are also most effective when used in conjunction with non-drug treatments.

Sometimes one medication will be prescribed and it either isn’t effective or the side effects are too much for the patient. This is not uncommon, and doesn’t mean medication isn’t an option. Different drugs work for different people. The doctor can find a different drug that might be a better fit for the individual.

Things to consider

As previously mentioned, these medications can have significant side effects. With antipsychotic medications especially, these drugs have been associated with increased stroke risk and death in older adults with dementia.2 These drugs can also bring out problems in movement, especially in people who have been misdiagnosed. For example, antipsychotics can impair movement and cause rigidity and falling in people with Lewy body dementia or Parkinson’s disease dementia.

Talk with the doctor about whether the benefits outweigh the risk for these medications, and what all of the possible side effects might be. It is also worth considering that no drug is currently approved by the FDA to specifically treat behavioral symptoms associated with dementia. These drugs are often prescribed “off-label.”

Choosing a drug treatment for any symptom is a major decision. Talk to the doctor about the behavioral symptoms that are occurring, and what some possible options are for treatment. If a person with Alzheimer’s disease has already gone through multiple non-drug treatments that have not been effective, medication might be the next choice. Their doctor can find the drug that best fits the needs of the patient and the situation to help manage symptoms and improve quality of life.

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