In a retrospective study of 22,890 patients aged 65 years and older in Pennsylvania (N. Engl. J. Med. 2005;353:2335–41), atypical antipsychotics and conventional antipsychotics were equally associated with risk of death in elderly patients, and the investigators wrote that use of any antipsychotics for AD should be avoided. In April 2005, the Food and Drug Administration issued a black box warning on the use of atypical antipsychotics to treat Alzheimer's.
Given the lack of evidence to support a genuine benefit from drug therapy, other nonpharmaceutical strategies can be used to help manage the symptoms and behavioral problems associated with AD. Simple empathy and thinking outside the box can work wonders. For example, simply positioning a person's wheelchair in a different direction so he or she is not looking at a person or object that triggers bad behavior can be amazingly helpful, Dr. Finucane said. “Don't confront the patients. Try to talk civilly to them,” he explained. For example, when Mom says she wants to go home, rather than arguing with her, suggest, “We are just fixing your dinner now. Why don't we finish that and then talk about this request of yours.”
Bad behavior toward caregivers is a chronic problem in long-term care facilities. However, education can be as helpful as medication in addressing this problem, Dr. Finucane said. The same is true for patients who touch caregivers inappropriately; try education before medication.
Finally, some AD patients have enough insight into their condition to become extremely depressed, and antidepressants can be helpful for managing their depressive symptoms, Dr. Finucane said. However, the bottom line remains that drug treatments for AD symptoms rarely are significantly helpful in improving the quality of patients' lives and their caregivers' lives.