Tuesday, 24 May 2016

Easing the Behaviour Problems of Alzheimers Disease

Doctors write millions of prescriptions a year for drugs to calm the behaviour of people with Alzheimer’s disease and other types of dementia. But non-drug approaches actually work better, and carry far fewer risks, experts conclude in a new report.

Non-drug approaches should be the first choice for treating dementia persons’ common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions, say the researchers in a paper just published by the British Medical Journal.

Clinicians at the University of Michigan and Johns Hopkins have developed a strategy to minimize the use of potentially dangerous drugs for behaviour problems.

The approach is called DICE – for describe, investigate, create and evaluate – and is based on data collected from two decades of research studies. The strategy is intended to be collaboration among doctors, caregivers and, when possible, the person with Alzheimer’s disease and involves the following steps.


Describe - First, caregivers and AD persons should describe the “who, what, when, where and why” of specific behavioural problems that the person with Alzheimer’s disease might be dealing with, including times of day they may occur, circumstances or situations that trigger them, and the level of distress that they cause. If someone becomes agitated and tends to pace in the evenings after the TV set is turned on, for example, that information should be conveyed to the doctor.

Investigate - The doctor or other health care provider should examine the person with Alzheimer’s disease to look for any underlying medical or environmental causes that may be contributing to the problem. A variety of medications, for example, can cause problematic side effects or interfere with sleep. Similarly, a lack of daily routines, poor lighting in the home or excess clutter can be confusing for someone with dementia and increase anxiety.

Create - Working together, caregivers and health care professionals should develop a plan to respond to behavioural issues and prevent future problems. These might include establishing regular routines for the person with Alzheimer’s disease, and providing education and support for caregivers.

Evaluate - Finally, the doctor should assess whether the plan is working, and make adjustments as needed.

The DICE approach can be more effective and safer than prescription medications such as haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal), all of which significantly increase the risk of death, the authors say. They note that sometimes the use of such drugs is appropriate, for example, if someone with Alzheimer’s disease poses a risk to themselves or those around them. And antidepressants can be useful for treating someone with serious depression. But in many cases, a non-drug approach should be tried first, they say, and any drugs that are prescribed should be monitored and discontinued when possible.

For anyone with Alzheimer’s disease, it’s important to assess whether he or she might be suffering from physical problems that are exacerbating the difficult behaviour. Being hungry, thirsty or in pain can all lead to outbursts. Untreated medical problems, such as a urinary tract infection, a toothache or interactions between different drugs, can also contribute to problems. Poor vision or hearing can also be disorienting and contribute to behaviour problems. Treatment of the underlying medical problem can help to ease agitation.

In the home environment, over stimulation or lack of stimulation can also aggravate behavioural problems. A loud TV or radio can be unpleasant for someone with Alzheimer’s disease, and that person may not be able to communicate his frustration or make the mental connection to go and turn the noisy device off. Lack of activity or lack of routines can likewise lead to confusion and contribute to behaviour problems.

“The evidence for non-pharmaceutical approaches to the behaviour problems often seen in dementia is better than the evidence for antipsychotics, and far better than for other classes of medication,” said study author Dr. Helen C. Kales, Head of the University of Michigan Program for Positive Aging. “The issue and the challenge is that our health care system has not incentivized training in alternatives to drug use, and there is little to no reimbursement for caregiver-based methods.”

The best evidence among non-drug approaches is for those that focus on training caregivers - whether they are spouses, adult children or staff in nursing homes and assisted living facilities - to make behavioural and environmental interventions.

For caregivers, stress and depression can diminish coping skills. Caregivers need education about the disease and should be taught skills about communicating with a loved one with Alzheimer’s disease. Caregivers also need to have realistic expectations about the course of the disease, the lack of effective treatments, and challenges that may arise.

The authors describe five non-drug approaches to caregiving that have been shown to help reduce behaviour issues. They include:

1.    Providing education for the caregiver;
2.    Enhancing effective communication between the caregiver and the person with dementia;
3.    Creating meaningful activities for the person with dementia;
4.    Simplifying tasks and establishing structured routines; and
5.    Ensuring safety and simplifying and enhancing the environment around the Alzheimer’s person, whether in the home or the nursing/assisted living setting.

Specific measures might include:

1.    Removing clutter from the home;
2.    Using calming music or simple activities that help to engage a person with dementia; or
3.    Using a calm voice instead of being confrontational.

It’s also critical that caregivers get breaks from their responsibilities and take care of themselves, especially in the home, to help them avoid burnout and taking their frustration out on the persons living with Alzheimer’s.

“Behaviour-based strategies may take longer than prescriptions,” acknowledges Kales, a member of the U-M Institute for Healthcare Policy and Innovation. “But if you teach people the principles behind DICE, the approach becomes more natural and part of one’s routine. It can be very empowering for caregivers or nursing home staff.”

More research on both new drug options and the best ways to assess and address behavioural symptoms is needed, the authors conclude. But in the meantime, the evidence to date comes down in favour of non-drug approaches in most cases.

(Source:  By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University. Helen C. Kales, Laura N. Gitlin, Constantine G Lyketsos: “State of the Art Review: Assessment and management of behavioural and psychological symptoms of dementia.” BMJ, March 2, 2015.)

Should You Go Generic?

If you take multiple prescription medications, you know their costs can add up. One way to save money is to ask your doctor if a generic is available - but are generic drugs as effective as more expensive brands? Yes, says the American College of Physicians, a doctors group that issued a statement in the January issue of Annals of Internal Medicine that advises all clinicians to prescribe generic drugs when possible.

“The biggest difference between brand-name medications and generics is cost,” says Claudene George, M.D., R.Ph., Assistant Professor of Clinical Medicine and Geriatrics at Albert Einstein College of Medicine in New York. “Companies that develop brand-name drugs invest in research, development and marketing - which drive up cost. Generic manufacturers can produce medications more cost-effectively.”

Here are five more facts to consider:

1.    Generics have the same active ingredients as brand-name drugs. 
New drugs have patents that protect them from being reproduced by other companies for typically 17 years. Once the patent expires, other manufacturers can sell the drug. The U.S. Food and Drug Administration approves only generics biologically equivalent to their brand-name counterparts, although inactive ingredients may differ. Generics may have a different shape, color or flavor. Rarely do these variations make a difference in effectiveness or side effects.

2.    Studies have compared generics vs. brand-name drugs.
The research has largely found the effectiveness of both is the same and brand names offer no superiority.

3.   The same pharmaceutical companies that produce brand-name drugs often manufacture generics
Five of the top 10 generics manufacturers are brand-name pharmaceutical companies.

4.    You’re more likely to take a generic drug as directed
That’s partly because generics have lower out-of-pocket costs. The higher costs of brands have consistently been associated with lower adherence rates because patients may skip taking some doses or filling prescriptions altogether to save money.

5.    Doctors report they’re influenced by patient requests. 
       In a recent survey, four in 10 doctors said they sometimes or often prescribe a brand name when a generic is available because the patient wants it. If your doctor prescribes a drug, ask whether a generic that works just as well is available.

If you switch from a brand name to a generic, be aware of any new changes in your medical condition or any side effects, says Dr. George. Although rare, it’s possible to experience minor differences when switching.

(Source:  HealthAfter50, posted in Healthy Living on 24 May 2016)

Saturday, 7 May 2016


Dear All,

ADFM will be conducting a Two-Day Four Module "Living with Dementia" Training Workshop on:


Saturday, 14 May 16 (8.30am - 6.00pm)
Module One – Understanding of Dementia 
Module Two – Behavioural Effects of Dementia 

Sunday, 15 May 16 (8.30am to 6.00pm)
Module Three - Effective Communication Skills 
Module Four – Activities for Living and Pleasure 

Group Size:  Limited to 20 – 25 participants only


This Training Workshop is designed to equip the caregivers with a deeper understanding of dementia on a person-centered approach to care, practical skills and strategies in responding to and handling the different challenges, and to make a difference to the life of a person with dementia.

It is designed to be an informative and interactive workshop with video-aided presentation, case study analysis and sharing, and group discussions.

The workshop focuses on:

·   Understanding the nature of dementia.
·   Understanding behaviour and person-centered care approaches to behavioural changes.
·   Strategies to communicate and interact more effectively.
·   Importance of creating an engaging physical environment with meaningful activities in a person-centered way in dementia care.

Workshop Facilitators:  Geriatrician Dr Elizabeth Chong and Dr Khor Hui Min,  Nurse Educator Ms Tan Saw Cheang and Ms Foo Sook Lee.  

Target participants:  Family caregivers and individuals caring for people with dementia.

Certificate of Attendance:  Will be issued to healthcare providers.

(i)   RM80  per participant for family caregivers  
(ii)  RM150 per participant for other individuals

Payment:  Bank in direct to ADFM Bank Account with CIMB at Account No. 800 229 3277. If Cheque, should be crossed and addressed to "Alzheimer's Disease Foundation". Email copy of payment slip to jenny@adfm.org.my for confirmation of registration and accounting record.   

Registration:  Email completed Registration Form to jenny@adfm.org.my.

More details, contact Jenny at 016 608 2513 / 03 7931 5850 or via above email.

Kind regards.