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Treatment of Behavioral Symptoms: When to Consider Antipsychotic Medications in LBD - Page 2

Managing Behavioral Symptoms Without Medication

It may be possible to reduce the frequency and severity of behavioral symptoms in LBD without medications. For example, new behavioral symptoms or a worsening of symptoms may be caused by physical reasons such as injuries, fever, urinary tract or pulmonary infections, pressure ulcers (also called bed sores), and constipation. Caregivers and physicians should check for these causes before prescribing medication to control behavioral symptoms. When these issues are properly treated, behavioral symptoms often decrease.

Sometimes the medications used to treat other LBD symptoms or other diseases will increase behavioral problems.  For example, over-the-counter sleep aids, bladder control medications, and dopaminergic drugs used to treat the motor symptoms of LBD (such as tremors, shuffling walk, and stiffness in arms or legs) can cause confusion, agitation, hallucinations, and delusions. Similarly, benzodiazepines, which are sedative medications typically given to treat anxiety, can actually lead to increased anxiety or worsen cognition in people with LBD. Consult with your loved one’s physician about the possibility of eliminating these medications or reducing their dose.

Because people with LBD are not able to explain why they are frustrated, frightened, or feeling overwhelmed, they may exhibit behavioral symptoms as an expression of these feelings. Caregivers can help to control these feelings (and resulting behavioral symptoms) by reducing sources of stress and anxiety in the home environment. For example, people with LBD do best with simple tasks and consistent schedules. They benefit from regular exercise and need adequate sleep. Also, excess environmental stimuli like noise or large crowds may make people with LBD feel overwhelmed. Reassuring the person with LBD or offering distractions can prevent behavioral problems when something upsetting happens.

It can be hard for families and people with LBD to cope with hallucinations and delusions. However, hallucinations and delusions can be very real to the people with LBD who experience them. Because people with LBD can lose their ability to evaluate facts and follow a rational argument, you may not be able to reason with them or prove that they are mistaken. For some people with LBD the more you try to prove that a hallucination or delusion is not true, the more agitated and anxious the person will become.  It is best to try to respond to the concerns or emotions the person with LBD is expressing.  It is worth noting, however, that some people with LBD will be able to recognize that the hallucinations are not real; in this circumstance no behavioral or medical intervention may be necessary.

People with LBD often mirror the feelings and emotions of people around them. Remember that people with LBD are not irritable or anxious on purpose. By keeping calm, understanding the other person’s feelings, and offering reassurance caregivers can help to control or avert behavior problems. Additional tips on handling behavior problems can be found on LBDA’s website in the article Understanding Behavioral Changes in Dementia.