Hi,
Brief answer: Non-pharmacological therapy is the preferred treatment of agitation and aggression behaviors in
dementia patients.
Detailed answer: Behavioral and psychological symptoms of dementia (BPSD) including agitation and aggression are common and present challenges to caregivers of dementia patients. Foremost medical evaluation is warranted to rule out a medical explanation for agitation or aggression, including infection (e.g.,
urinary tract infection) or a drug side effect. If agitation and aggression is not due to an underlying medical condition as described, non-pharmacological therapies have proved effective in treating and managing BPSD and this is the preferred treatment. Non-pharmacological interventions include communication skills therapy, physical activity, outside nature sensory therapy, music therapy, and pet therapy. Neurocognitive interactive technology such as the Paro Robotic Seal have also been used.For some patients, non-pharmacological therapies may not prove effective, and so therapy with antipsychotics, antidepressants, or anti-epileptics along with cognition-enhancing medication (
Aricept) is warranted. Drugs are not first line treatment because they have have been shown to have adverse effects (e.g., sedation,
urinary retention) and risks In dementia patients including increased risk of falls and
stroke.
Citalopram (Celexa) is an antidepressant and anti
anxiety drug in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). While citalopram may help improve agitation, it can also worsen it when initially starting this drug. Additionally, citalopram has been shown to be associated with increases mortality because of its adverse effects on the electrical conduction in the heart. (via prolongation of the QT interval).I recommend caregivers exhaust all non-pharmacological therapy options before considering starting treatment of BPSD with drugs. I encourage you to talk with your mother’s doctor about your concerns so that your mother can receive appropriate treatment for her agitation.Hope this helps answer your query. Let me know if I can be if further assistance.
Regards,
Dr. Shapiro, MD