Anxiety,Aggression,Hostility: Treatments For In Alzheimer's Disease

    A number of drugs and compounds have been used with varying effectiveness for the treatment of agitation and anxiety in alzheimer patients. Haloperidol or thioridazine have been widely used to control agitated patients. Both seem to work equally well, but haloperidol seems to cause more parkinson-like side effects,known as extrapyramidal symptoms [20]. Some studies have shown the haloperidol more effectively controls agitation when combined with other agents. For example, one study reports that carbamazepine and haloperidol controls agitation better than haloperidol by itself [21].
    Sometimes, behavior management techniques can control agitation. A very recent study finds that proper behavior managament by staff is just as effective in controlling agitation as haloperidol or trazodone [22]. What are behavior management techniques? When you have an anxious or agitated person, try to use some of the following techniques:
1. Approach the patient in a gentle,calm manner.
2. Always try to orient a patient to his/ her room.
3. Use the patient's name frequently.
4. Approach patient from the front, not the side.
5. Reassure the patient that you understand their anxiety.
6. Don't tell patients what they should not do; instead focus on what they should do. For example, don't say:"Don't go outside", but do say:"Please stay inside".Patients find it easier to understand a simple command.     Some antidepressant compounds of the benzodiazepine class, such as trazodone, are quite effective at reducing agitation in alzheimer patients [23-24]. Twenty five milligrams,given three times daily, seems to decrease anxiety [25]. The major side effect at higher doses is dry mouth.
    Other less- used compounds have been shown to control agitation,sometimes when nothing else seems to work. Phosphatidylserine, sold in health food stores, decreases anxiety [26]. Propanolol, in daily doses from 10 to 80 milligrams daily, can control aggression in highly aggressive patients even after two weeks [27]. Medroxy-progesterone acetate,an anti-androgen, completed stopped all physical and verbal aggression in 3 demented patients with extremely high aggression and hostility [28].     Some drugs can actually increase hostility in alzheimer patients. Scopolamine, a cholinergic blocker, increases hostility more in alzheimer patients than in non-demented controls [29].
    Some drugs decrease anxiety, but come with additional costs to the patient. Benzodiazepines have been widely used to control anxiety. Diazepam is one drug in the benzodiazepine class. Benzodiazepines can actually worsen cognitive abilities [30-31] and increase the risk of falls [32-33]. Alzheimer patients,as you may know, are more prone to falls because of a slowed gait and poor balance.

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