Medications to Manage Behavioral Symptoms of Alzheimer’s

Alzheimer’s disease is the most common form of dementia. In the early stages, some people with Alzheimer's may not show any psychiatric or behavioral symptoms. Or they may only have mild symptoms. But as the disease progresses, changes in behavior are common. Up to 9 out of 10 people have at least 1 psychiatric symptom within 2 years of diagnosis.^1,2

Behavioral changes can be among the hardest symptoms of Alzheimer’s to manage. In early stages, common personality changes include:¹

• Irritability
• Anxiety
• Depression

Later, more troubling psychiatric symptoms may appear. These include:^1,2

• Aggression, anger, agitation, and paranoia
• Wandering
• Physical or verbal outbursts
• Sensing things that are not there (hallucinations)
• Believing in things that are untrue (delusions)
• Problems sleeping

Why treating behavioral symptoms is important

Behavioral and psychiatric symptoms can be some of the most distressing as Alzheimer's progresses. They may also be dangerous.¹

For example, psychiatric symptoms can make it difficult to care for the person safely. These symptoms are also deeply disturbing to loved ones. Untreated psychiatric symptoms can lead to caregivers having to put the person with Alzheimer's in memory care sooner.²

What causes behavioral symptoms in Alzheimer’s?

The main cause of psychiatric symptoms is damage to brain cells. But other health issues may be the cause of behavioral symptoms in people with dementia. For example:^1,2

• Pain from an underlying infection or poor sleep may cause agitation or anger.
• Depression may cause irritability and apathy.
• Untreated vision and hearing problems can lead to more confusion.

The way different drugs act on each other in the body (drug interactions) are another common cause of worsening or unpredictable behavior. The best approach to treating problem behavior is to look for and treat any underlying conditions.²

But there are times when prescription drugs are needed to manage the behavioral and psychiatric symptoms of Alzheimer’s and dementia.^1,2

Drugs that treat behavioral symptoms

The 3 main types (classes) of drugs used to treat behavioral and psychiatric symptoms of Alzheimer’s are:^1,2

• Antidepressants
• Anxiolytics
• Antipsychotics

Antidepressants

Doctors may prescribe antidepressant drugs to help manage:²

• Depression
• Agitation
• Paranoia
• Sleep problems

If prescribed for depression, selective serotonin reuptake inhibitors (SSRIs) helped improve symptoms of depression. But SSRIs prescribed for behavior issues other than depression show mixed results.²

In studies, the SSRI citalopram (Celexa®) helped with agitation and paranoia in people with Alzheimer’s who were nonverbal.²

Other SSRIs that may be prescribed for low mood and irritability include:¹

• Fluoxetine (Prozac®)
• Paroxetine (Paxil®)
• Sertraline (Zoloft®)

Trazodone (Desyrel®), an antidepressant that also works on the serotonin system, can help people fall asleep.²

Studies found removing someone from antidepressants was linked to much worse depression, and somewhat worse psychiatric symptoms if prescribed for symptoms other than depression. People who have Alzheimer’s and heart issues may need to avoid taking antidepressants. That is because these drugs can increase the risk of:²

• Stroke
• Heart attack
• Irregular heartbeat (arrhythmia)

Anxiolytics

A group of drugs called anxiolytics are sometimes prescribed for anxiety, restlessness, resistance, and verbally abusive behaviors. These drugs include:¹

• Lorazepam (Ativan®)
• Oxazepam (Serax®)

Antipsychotics

Antipsychotics may be prescribed for aggression or hostility, agitation, and delusions or hallucinations. These drugs include:^1-4

• Aripiprazole (Ability®)
• Brexpiprazole (Rexulti®)
• Clozapine (Clozaril®)
• Haloperidol (Haldol®)
• Olanzapine (Zyprexa®)
• Risperidone (Risperdal®)
• Ziprasidone (Geodon®)

While antipsychotics are often prescribed for people with Alzheimer’s, these drugs should be used carefully. Research shows that antipsychotics are linked to higher rates of stroke and death in older people with dementia. For this reason, many of these drugs include boxed warnings about their use in people with Alzheimer’s. A boxed warning is the strictest warning from the US Food and Drug Administration (FDA).^1,2

Before beginning treatment for Alzheimer’s, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.