Treatment for the noncognitive secondary behavioral effects of Alzheimers Disease

What is the treatment for the noncognitive secondary behavioral effects of Alzheimers Disease? 

Behavioral symptoms, such as disturbed sleep, depression, anxiety, psychotic features, agitation, and aggressiveness, are amenable to treatment.

Behavioral modification, such as entraining sleep–wake cycles and increasing daytime activity, should be tried first for sleep disorders 

Depression , particularly early in the disease, may respond to low doses of antidepressants, but drugs with anticholinergic side effects should be avoided.

Drugs that act on the serotonergic system may be better tolerated (fluoxetine, paroxetine, citalopram, sertraline), although controlled studies are lacking for patients with AD. 

Anxiety and agitation frequently respond to behavioral interventions, such as day center participation, that engage the patient and reduce caregiver stress.

Other respite interventions for caregivers may help to reduce patient stress.

If symptoms are infrequent, anxiety or agitation may be treated with low doses of anxiolytics as needed.

Chronic anxiolytics are not indicated for Alzheimers Disease, but short-term therapy with buspirone or lorazepam may be justified during periods of transition or change. 

Environmental triggers and pain should always be ruled out as causes of agitation before using drugs. 

Severe agitation, aggressiveness, and psychotic features that disturb the patient should be treated with atypical antipsychotics such as olanzapine, risperidone, and quetiapine, in the lowest doses possible, because these drugs further impair cognition (and sometimes motor performance).

Antipsychotics have black box warnings for dementia patients on their labeling.

Psychotic features that do not disturb the patient or disrupt the household need not be treated.

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