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Agitation
is one of the most common behaviours of a person with
dementia, for which drug management is used. Yet multiple
drug use itself is a major cause of agitation. (People
over the age of 65 consume about 25% of all medications
prescribed in Australia. It is not unusual for these
people to take two or more different types of medications
daily.)
Treating
a side effect of medications with another drug simply
increases the problem.
Other
conditions such as urinary tract infections, depression
and pain can also cause agitation. Once these conditions
are treated specifically, the symptom of agitation
should disappear.
Frustration
at not being able to communicate effectively and make
oneself understood is often expressed in agitated
behaviour in a person with dementia. Drugs don't cure
communication difficulties. Behavioural treatment
should be the primary approach to the treatment of
most forms of agitation, especially non-aggressive
behaviours such as wandering and pacing. The following
behaviours are most often non-responsive to drug therapy:
wandering; socially inappropriate activities; repetitive
actions and speech; difficult personalities; hoarding
and stealing.
Many
drugs block the effects of acetylcholine, a chemical
already in short supply in Alzheimer's disease, and
as a result worsen memory, thought processing and
cause further behavioural disturbances. These include:
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antipsychotic
drugs & some antidepressant drugs. Side effects
include drowsiness, sleep disturbances, low
blood pressure, movement disorders, difficulty
urinating, constipation, increased confusion
and memory loss.
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drugs
for movement disorders such as Parkinson's disease.
These tend to cause psychotic type symptoms
eg. hallucinations and delusions. They can also
lower blood pressure leading to falls.
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antihistamine
drugs and many over-the-counter cough and cold
preparations.
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narcotic
pain killers are associated with increased sedation
and constipation.
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anti-ulcer
drugs can increase confusion.
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Drugs
used for treating bladder problems, stomach
and abdominal cramps, and nausea, can also worsen
the symptoms of dementia.
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