Less Medication, More Care for Dementia Patients

Personalized dementia treatment plans that integrate patients and caregivers may improve care

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Caring for a family member with dementia can be difficult. A structured treatment plan, however, may help you and your loved one.

A recent paper reviewed current treatment of dementia and suggested a personalized treatment plan that highlights the caregiver rather than medications. The treatment program focused on four components: Describe, Investigate, Create and Evaluate (DICE).

“The evidence for non-pharmaceutical approaches to the behavior problems often seen in dementia is better than the evidence for antipsychotics, and far better than for other classes of medication,” said lead study author Helen C. Kales, MD, in a press release.

Dr. Kales, director of the Program for Positive Aging and associate director for mental health and aging research at the Geriatrics Center at the University of Michigan, continued, "The issue and the challenge is that our health care system has not [emphasized] training in alternatives to drug use, and there is little to no reimbursement for caregiver-based methods.”

"I agree with Dr. Kales that the classic medication therapies are lacking in efficacy, and yet they are the go-to items by those in classic medical systems," said Tom Schnorr, RPh, CCN, owner of Austin Compounding Pharmacy in Austin, TX.

"Long term, they fail to show any measurable results in as little as 12 weeks," Schnorr told dailyRx News. "There are success stories using hyperbaric chambers, IV chelation and other functional medicine procedures. I have seen patients respond to nutritional protocols that include [the antioxidant] glutathione for them."

Dementia is a general symptom of mental decline or confusion. It can be caused by many diseases or injuries. In 2013, dementia was estimated to affect 44 million people worldwide, Dr. Kales and team noted. This number is expected to climb to 76 million by 2030.

The psychological and behavioral symptoms of dementia require the most treatment. These include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems and wandering.

Those who care for dementia patients often suffer stress and depression. Education and support is key, Dr. Kales and team said. Teaching caregivers how to communicate, tackle behavior and reduce stress have been shown to benefit both them and the patient.

Non-medication treatment is recommended for dementia (except in cases of possible harm). However, medications are still used quite often. This is likely due to ease of administration and lack of knowledge of other options.

Dr. Kales and team outlined an alternative strategy to decrease medication use in dementia treatment. Called DICE, this plan focuses on using the caregiver to develop a personalized treatment plan.

Describe: Caregivers often know the patient best. They should catalog all behaviors, medicines and triggers.

Investigate: The doctor should look into all medicines. He or she should check for any underlying health conditions. Patients with dementia may be unable to communicate a health problem.

Create: A specific plan should be designed for the caregiver to follow. Dr. Kales and team recommended the following five items:

  • Providing education for the caregiver.
  • Enhancing communication between the caregiver and patient.
  • Creating meaningful activities for the patient.
  • Simplifying tasks and establishing routines.
  • Ensuring safety and simplifying and enhancing the environment.

Evaluate: Revisit the plan. Make changes. If possible, try lowering doses or removing medications.

This approach to treating dementia highlights the caregiver, Dr. Kales and team noted.

"It is our hope that healthcare systems will recognize the benefits of such approaches and compensate providers for time spent on the prevention, assessment, and management of behavioral and psychological symptoms of dementia," Dr. Kales and colleagues wrote.

This review was published online March 2 in The BMJ.

Grants from the National Institutes of Health and the Johns Hopkins Alzheimer’s Disease Research Center funded this research. Dr. Kales and team disclosed several conflicts of interest, such as ties with Pfizer, GlaxoSmithKline, Novartis and AstraZeneca.

Review Date: 
March 5, 2015
Last Updated:
March 9, 2015