Neuroleptic
Antipsychotic medications are prescribed frequently for patients with Alzheimer's disease to reduce behavioural disturbance. Many neuroleptics possess anticholinergic activity and it is probable that this accelerates cognitive impairment. Elderly patients are particularly susceptible to the adverse consequences of neuroleptics and those with lewly body dementia even more so. In practice antipsychotic medication is an essential component of a management strategy to control otherwise intractable behavioural disturbance but should be used cautiosly, start low, increase slowly.
Antidepressants
Depression in dementia is treatable, although assessment of response is difficult. Older tricyclic antidepressants possess significant anticholinergic action and their theoretical effects on cognitive decline (predicted to hasten) and poor tolerability in the elderly. Relatively few trials of antidepressants in dementia have been conducted.
Sleep Hygiene
Sleep can be disturbed by many factors, including physical causes such as musculoskeletal pain and nocturia, and psychological causes such as depression and anxiety, in additon to the change in sleep/wake cycle that is intrinsic to many cases of Alzheimer's disease. Before considering pharmacological treatments a thorough search should be made for the causes of sleep loss. Behavioural approaches to treatment include sleep hygiene management which addresses:
- Time of sleep, A routine appropriate to age should be followed. Six hours of sleep is more than enough for most elderly people and the patient should be encouraged to retire at an appropriate time and expect to wake 6 hours later.
- Daytime sleeping should be avoided
- Place of sleep. Bedrooms should be quiet, dark and for sleep only. Not for napping during the day, watching TV or eating meals.
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