A 2019 meta-analysis examining 163 studies and over 23,000 people with dementia finds that antipsychotics and other go-to off-label treatments for dementia symptoms may not be the most effective approach.
While forgetfulness and cognitive decline are the main defining symptoms of dementia or Alzheimer’s, the conditions are also often riddled with behavioral issues and aggression, which can be burdensome for both patients and caregivers. Certain drugs, like antipsychotics, can be used to treat these behavioral issues, or at least ease them a bit. But a 2019 meta-analysis examining 163 studies and over 23,000 people with dementia finds that drugs may not be the most effective treatment path.
Drug vs. non-drug approaches
The researchers reviewed past studies that analyzed the efficacy of non-drug treatments for aggression in dementia. They found that being outside, getting massages and even music all showed positive benefits for reducing agitation and aggression in people with dementia—more so than antipsychotics.
Antipsychotics, like quetiapine and risperidone, are commonly prescribed to patients to help calm their aggressive behavior. But antipsychotics come with their own side effects, like an increased risk of stroke and falls. One recent study also found that antipsychotics were linked to a rise in hospitalizations among dementia patients.
The conclusion of the latest study was straightforward: “Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia,” the authors wrote.
Outdoor activities in particular, like gardening, showed more efficacy in reducing physical aggression in dementia patients than antipsychotic medication. Physical touch, like massage and touch therapy, also showed to be a better alternative to drugs for treating verbal aggression.
Addressing the root cause of aggression
But why do these seemingly simple non-drug approaches seem to work better? The authors believe it may have something to do with addressing the root cause of the aggressive behavior.
“Nonpharmacologic interventions may be efficacious because behavior has meaning, which needs to be uncovered through multidisciplinary assessments and care that addresses underlying needs,” the authors wrote.
According to the Social Care Institute for Excellence, aggressive behavior in people with dementia can be thought of as a reaction rather than a symptom. Instead of assuming the person with dementia is being purposefully angry or aggressive, it’s important to understand that it’s more likely they are experiencing fear, discomfort or frustration in feeling unheard.
Figuring out the message behind a person’s aggressive behavior can help make it easier for caregivers to address it. Massaging a person’s hand, taking them outside for a walk, helping them feel more comfortable or changing their scenery could be good options in addressing their feelings.
Though the authors of the study recommend trying nonpharmacologic approaches to treat aggressive behavior, discussing it with a doctor first may be the best option. Some patients may require drugs, and some may benefit from a more comprehensive approach that uses both drug therapy and holistic activities.