DEMENTIA Many drugs don't work, review says

Researches noted alternative therapies, such as caregiver education, should be considered.
Many of the drugs that are commonly prescribed for dementia symptoms such as agitation and delusions are not effective, researchers concluded after reviewing studies done over the past four decades.
Alzheimer's disease and other forms of dementia are mainly characterized by memory deficits. Other behavioral symptoms, including aggressive behavior, hallucinations and wandering, are common in 60 percent to 98 percent of all patients, particularly in the later stages of disease.
"Dementia-related behaviors are very distressing to both caregivers and medical professionals," said Dr. Kaycee Sink, a geriatrician at Wake Forest University Baptist Medical Center. She is the lead author of a clinical review published today in The Journal of the American Medical Association.
"It was discouraging to find that we currently don't have good drug therapies for them. There is no clear standard of care, and treatment is often based on local prescribing customs."
Dementia rates
More than half of those over age 85 are affected by dementia. Dementia-related behavioral problems are associated with longer hospital stays and often force caregivers to place loved ones in nursing homes. About 30 percent of the cost of caring for patients with Alzheimer's is associated with managing behavioral symptoms, Dr. Sink said.
She and Drs. Karen Holden and Kristine Yaffe of the University of California-San Francisco reviewed data from 29 clinical studies of 15 drugs commonly prescribed for dementia symptoms, including anti-psychotics, anti-depressants and mood stabilizers. The researchers did not consider the effectiveness of drugs given only to treat depression.
They found that two newer-generation anti-psychotic drugs -- risperidone and olanzapine -- offer the best evidence for effectiveness against nonmemory-related symptoms of dementia.
"However, the effects are modest and are complicated by an increased risk of stroke," the researchers wrote. "Physicians considering prescribing these drugs should discuss the potential risks and benefits with patients and their caregivers."
The researchers said because there is "no gold-standard outcomes" for improvements in symptoms, it is difficult to interpret small changes in various scores used by the studies. Many studies don't use behavioral symptoms as criteria for patients to be included.
Dementia-drug studies also don't use results such as nursing-home placement or caregiver burdens and depression, Sink and her colleagues said, but suggest that they should.
With federal spending on dementia care expected to triple in the next decade, the researchers said it is essential to find more effective treatments for the symptoms.
Alternative therapies
They noted that nondrug therapies should always be considered first, after a careful examination rules out physical or environmental causes for a symptom other than dementia. The team pointed to a number of small studies showing that steps such as music therapy, aromatherapy, pet therapy and caregiver education may be helpful.
"We need larger, well-designed controlled trials of these nondrug interventions," Sink noted. The team also said continuing studies of other drugs are needed, and pointed to a new large study now under way comparing four new-generation anti-psychotic drugs as being particularly useful.

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