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A review published July 2017 in The Journal of the American Osteopathic Association focuses on the off-label use of antipsychotic medications in older adults with dementia, and why caregivers should take caution with these medications, according to U.S. News & World Report.

Dementia is a brain disease that causes long-term decline in the ability to think, remember, problem-solve, or speak. As dementia becomes more severe, most older patients experience behavioral and psychologic symptoms (BPSD), such as verbal and physical aggression, agitation, hallucinations, and wandering.

The new research found that up to 90 percent of dementia patients will experience at least one BPSD, and over 30 percent of these cases will be severe enough to put the patients themselves and their caregivers in danger.

The controversy arises over how to treat these severe symptoms.

Medications that are FDA-approved to treat dementia target the cognitive symptoms, but do not relieve the behavioral and psychologic symptoms. As a result, caregivers turn to off-label treatment for BPSD.

These off-label treatments are often antipsychotic medications, such as Abilify, Haldol, and Risperdal. These drugs are FDA-approved to treat schizophrenia and bipolar disorder, but they are not approved to treat dementia-related psychosis.

In fact, the FDA has placed a black box warning on these antipsychotic medications, stating that they are associated with an increased risk of death in elderly patients being treated for dementia-related psychosis.

The causes of death in these cases are often cardiovascular or infectious in nature, such as heart failure and pneumonia.

Other negative side effects of these drugs include symptoms typically seen in Parkinson’s disease, such as stiffness, tremors, and balance problems.

The review published in July, led by Dr. Rengena Chan-Ting, an assistant professor of geriatric medicine at the Rowan School of Osteopathic Medicine, advocates for alternative treatments for BPSD other than antipsychotics.

The review notes that “a growing body of evidence suggests that antipsychotic use in the management of BPSD is associated with…health risks and only modest benefits,” as reported by U.S. News & World Report.

Alternative treatments for BPSD could include behavior management techniques and sensory stimulation, such as meditation, massage therapy, and even music therapy.

In some cases, however, antipsychotics may be the most effective, and sometimes the only, option available to dementia patients and their caregivers, depending on the severity of the symptoms. In these situations, Chan-Ting and other experts suggest low doses and only temporary use to reduce the risks.

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