Xanax, Valium May Boost Pneumonia Risk in Alzheimer's Patients

Researchers suspect people may breathe saliva or food into their lungs due to fatigue from the drugs

Alzheimer's patients given sedatives such as Valium or Xanax may have an increased risk for pneumonia, a new study warns.

People with Alzheimer's disease are often given these drugs, called benzodiazepines, over the long term, the researchers said.

Examples of benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan).

"An increased risk of pneumonia is an important finding to consider in treatment of patients with Alzheimer disease. Pneumonia often leads to admission to hospital, and patients with dementia are at increased risk of death related to pneumonia," Dr. Heidi Taipale, of Kuopio Research Center of Geriatric Care at the University of Eastern Finland, and co-authors wrote.

For the study, the researchers reviewed data from nearly 50,000 Alzheimer's patients in Finland. The patients' average age was 80 and about two-thirds were women.

The study found that people with Alzheimer's who took benzodiazepines were 30 percent more likely to develop pneumonia than those who weren't given the sedatives.

The risk of pneumonia was highest in the first 30 days after starting the drugs, the findings showed.

The researchers said their findings are consistent with previous studies.

Because benzodiazepines are sedating, it's possible that people taking them may breathe saliva or food into the lungs, increasing the risk of pneumonia, the study authors suggested.

Dr Heidi Taipale's team said the benefits and risks of these drugs -- including pneumonia -- need to be carefully considered before giving them to someone with Alzheimer's disease.

The study was published April 10 in the CMAJ (Canadian Medical Association Journal).

The study is "a good reminder to clinicians to 'first do no harm' when prescribing these drugs for frail older women and men with dementia. Non-drug "approaches should be the starting point when managing neuropsychiatric symptoms in this patient population, which should help to limit inappropriate use of these drugs," the editorial authors said.

(Source:  HealthDay News, 10 April 10 2017) 

When the Diagnosis Is Dementia: How to Cope

When you reach age 65, you have a one in 10 chance of developing dementia during your remaining lifetime. Clinicians are now making a concerted effort to diagnose dementia in the early stages when patients may still have the capacity to understand the disease's course and to make important decisions about future care and interventions.

Being told you have an incurable disease that slowly robs intellectual functioning can take an emotional toll. Adjusting to a diagnosis at any stage of dementia is a complex, evolving process for the person diagnosed and his or her family. You may experience mixed feelings and a range of reactions, including:

·         Loss of Self

Dementia poses a threat to personality and character. Understandably, dementia's symptoms, such as forgetting faces and struggling to express yourself, can leave feelings of loss, uncertainty and frustration. Experiencing acute grief and mourning your loss of self-identity is common.

·         Unawareness

Most individuals with Alzheimer's disease aren't aware they have impaired memory and thinking. For others, unawareness increases as the disease progresses. This suggests that unawareness is part of the brain disease in some individuals.  Arguing with them or repeatedly demonstrating to them that they're forgetful won't help and is likely to upset them more.

·         Denial

Other individuals outwardly deny or ignore the diagnosis of dementia but seem to be aware from their behavior that they have a problem. Research suggests that this reaction can sometimes be a self-monitoring strategy in an attempt to be seen by others as a person, not an object, and maintain self-esteem.

·         Relief

Certain individuals and their loved ones report feeling relief upon hearing the diagnosis of dementia. The anxiety of not knowing what's causing symptoms like forgetfulness can be a tremendous burden. A diagnosis can confirm suspicions that dementia is the cause and legitimizes the need for support and therapeutic interventions.

·         Secretiveness or Embarrassment

It's common for individuals to be reluctant to reveal their dementia diagnosis for fear of how others might perceive them. As a result, these individuals are often tempted to stop seeing friends or family members and become socially isolated - outcomes that are clearly undesirable, since studies show that maintaining social connectedness is key to coping with the psychological impact of a dementia diagnosis.

·         Anxiety, Anger, Sadness or Depression

These are all normal reactions. Demoralization is especially common in the disease's early stages the same way it is when grieving any other loss. Behavioral therapy or counseling may ease feelings of anxiety and depression if they interfere with everyday functioning.

(Source:  John Hopkins Health Alert, 9 June 2014)

PARANOIA AND DELUSIONS IN ALZHEIMER'S DISEASE

What Is Paranoia?

Paranoia is an unrealistic fear or concern that harm is imminent or that others are out to get you. A paranoid person does not generally accept other explanations and may blame you if you try to use logic to reason away their fears.

Some people experience paranoia if they have a psychological disorder like schizophrenia. Others develop it in relation to different medical conditions, including Alzheimer’s, other dementias or delirium.

What Are Delusions?

Delusions are fixed (not easily changed) false beliefs. Dementia often results in paranoid delusions, where there may be a fixed belief that someone is poisoning the food or stealing money. Other delusions, infrequently experienced by those with dementia, include delusions of grandeur, where there is the false belief that one has extra power or a higher position in society or the world.

An Example of Paranoia and Delusions in Alzheimer’s

Alzheimer’s can change the way others are perceived. For example, you may have always had a good relationship with your father and are trying to help him with his finances. Instead of being grateful for your assistance, your father, who has Alzheimer's, might accuse you of trying to take his money or "pull one over" on him.

Common Delusions in Dementia:

·         Spouse/partner is being unfaithful.

·         Someone else is living in their home.

·         Their belongings/money are stolen.

·         Others are out to get them.

·         Food is poisoned.

·         Prevalence of Delusions in Alzheimer’s Disease

Approximately 30% to 40% of people with Alzheimer’s will develop delusions at some point during the disease, many of them being paranoid delusions. The incidence may be increased in those who have a history of abuse or trauma.

Delusions appear to be more common in Parkinson’s-related dementia, vascular dementia and Lewy Body disease (LBD), with up to 70% of people with LBD experiencing delusions or hallucinations.

Could Paranoia or Delusions Be a Sign of Delirium?

If paranoia or delusions are a new behavior for your loved one or someone you’re caring for, consider the possibility that she might be experiencing delirium. Delirium is a sudden change in thinking and orientation, usually quite reversible, brought on by a physical condition such as an infection, surgery or other illness.

How Can You Decrease the Likelihood of Paranoid Delusions in Alzheimer’s?

Be careful what television shows are playing in the background. To you, it might just be background noise, but to a person who’s confused, violent or fear-provoking shows may trigger fear and paranoia for that person. For the person with Alzheimer’s, the line between reality and fantasy can easily become blurred.

Ensure that your loved one is receiving the correct medication doses. Too much or too little medication can affect a person’s mental and emotional stability.

If you’re providing care for someone in a facility, try to keep the routine as consistent as possible. A regular rhythm of the day and familiar, consistent caregivers help reduce anxiety and stress for people.

Responding to Paranoid and Delusional Behavior in Alzheimer’s:

·         Provide reassurances.

·         Remain calm.

·         Explain any procedures before performing them.

·         Avoid laughing or whispering near the person.

·         Don’t agree with the person that you did something that you didn’t do.

·         Use a behavior log (a way to track behaviors) to identify triggers and times of day they occur.

·         Don’t argue.

·         Use distraction.

·         Enter into their world. Put yourself in their shoes.

·         Help them look for things they think are stolen or missing.

·         Have duplicates of things they lose and think are stolen.

You may also need to consider the possibility that their fears are accurate - that someone is actually taking advantage of them. Older adults can be vulnerable to different types of abuse, including financial and physical. Most delusions in dementia really are delusions, but a healthy awareness (not constant suspicion) of others is the better part of wisdom.

(Source:  about.com, Alzheimer’s/Dementia)