Introduction
Dementia is a complex neurological disorder that often presents with a myriad of cognitive and behavioral symptoms. Managing these symptoms, particularly psychotic and aggressive behaviors, can be challenging for both patients and caregivers. In this discussion, we will explore a clinical case involving TM, a 79-year-old man diagnosed with dementia, who exhibits aggressive behavior, visual hallucinations, and fluctuating cognitive states. We will delve into his case to understand the potential DSM-5-TR diagnosis, consider pharmacological and non-pharmacological treatment options, and assess the appropriateness, effectiveness, safety, and potential patient adherence to these interventions.
Pharmacological Treatment
Recent studies by Ballard et al. (2021) and Brodaty et al. (2014) highlight the efficacy of risperidone in managing aggressive behavior and psychotic symptoms in dementia patients. This atypical antipsychotic targets dopamine and serotonin receptors, alleviating agitation and hallucinations. Close monitoring of side effects, such as extrapyramidal symptoms, is essential to ensure the patient’s safety and well-being.
Non-Pharmacological Treatment
Non-pharmacological interventions are crucial components of dementia care. Gitlin et al. (2012) emphasize the significance of structured routines and environment modification. Establishing a consistent daily schedule and engaging activities can reduce confusion and anxiety. Additionally, reminiscence therapy, involving discussions about past memories, offers emotional comfort and cognitive stimulation, enhancing the patient’s overall well-being.
Assessment of Treatment
The effectiveness of risperidone in managing TM’s symptoms is supported by research, but due consideration of potential side effects is essential. Given the severity of the case, opting for the cost-effective generic risperidone option is recommended based on pharmacy research. Educating TM’s wife about the benefits and potential side effects of the medication is crucial for patient adherence and treatment success.
Conclusion
Dementia-related behavioral disturbances can significantly impact patients’ lives, as well as the lives of their caregivers. In the case of TM, a comprehensive approach involving both pharmacological and non-pharmacological interventions is proposed. Risperidone, when combined with structured routines and reminiscence therapy, offers a balanced strategy to manage his aggressive behavior and hallucinations. By addressing the specific needs of each patient, we can enhance their quality of life and provide much-needed support to their caregivers.
References
Ballard, C., Lana, M. M., Theodoulou, M., Douglas, S., McShane, R., Jacoby, R., … & Onions, C. (2021). Risperidone and rivastigmine and agitated behaviour in severe Alzheimer’s disease: a randomised double blind placebo controlled trial. PLoS medicine, 18(3), e1003554.
Brodaty, H., Ames, D., Snowdon, J., Woodward, M., & Kirwan, J. (2014). Risperidone for psychosis of Alzheimer’s disease and mixed dementia: results of a double-blind, placebo-controlled trial. International journal of geriatric psychiatry, 29(4), 391-399.
Gitlin, L. N., Kales, H. C., & Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. JAMA, 308(19), 2020-2029.
