Treatment Strategies for the Behavioral Symptoms of Alzheimer's Disease: Focus on Early Pharmacologic Intervention

Manju T. Beier, Pharm.D., FASCP

Disclosures

Pharmacotherapy. 2007;27(3):399-411. 

In This Article

Nonpharmacologic Management of Behavioral Symptoms

Nonpharmacologic interventions have the potential to reduce the frequency and severity of behavioral symptoms in patients with dementia who reside in nursing homes.[13–26] Although the choice of technique depends on the target behavioral symptom, nonpharmacologic techniques target three broad problems: behaviors caused by unmet patient needs, those caused by aggravating factors, and those caused by ill-suited environments.[16] For example, removing any medical causes of problem behaviors (e.g., pain and delirium), reducing any excess stimulation in the environment, and eliminating any known triggers may reduce physical and verbal aggression. Use of nonpharmacologic techniques to manage behaviors in the nursing home helps physicians, pharmacists, nurses, and staff begin to view behaviors as symptoms of underlying medical and environmental problems. A group of authors showed that implementation of an education program that trained providers (e.g., nursing home staff, physicians, nurses, nursing assistants, and other direct care staff) in the use of structured guidelines to improve the management of behavioral problems and to minimize the use of antipsychotic drugs reduced the number of days of antipsychotic drug use by 72%, with no increase in behavioral symptom frequency.[27] Therefore, nonpharmacologic strategies can have meaningful benefits, such as a reduced need for psychotropic drugs. Table 1 summarizes some of the commonly used nonpharmacologic techniques and their associated outcomes. Several small studies have shown the often significant benefits of nonpharmacologic interventions, such as music therapy,[16,18] massage or aromatherapy,[16,20] and pet therapy.[14,16]

The current limitations in our understanding of the effectiveness of nonpharmacologic therapies for the management of behavioral systems in patients with Alzheimer's disease result from difficulties in recruiting patients for large-scale, randomized studies of these treatments. This is generally due to reluctance of caregivers and/or nursing home personnel, problems with implementation of treatments resulting from limitations in communication with patients, and insufficient funding.[16] Despite these limitations, nonpharmacologic interventions are the preferred first step in the management of behavioral symptoms. However, these approaches are not always completely effective. When this is the case, pharmacologic therapy should be considered.

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