Gloucestershire Health Community NHS

Guideline for Treatment of Agitation in Alzheimer’s Dementia

Step 1

Pain

Environmental Infection
Think
"PINCH ME"
to identify
treatable
causes of
Medication symptoms
Constipation

Hydration

Step 2: Psychosocial/caring advice: from primary care, consider referral to Community

Dementia Nurse or Care Home Support Team (which care homes can access direct)

Step 3: If taking an ACI drug (donepezil, rivastigmine or galantamine), reduce dose of it and add
memantine (see note below). Discuss with Community Dementia Nurse

Step 4: Stop ACI drug -any reduction in agitation usually apparent within 10 days

Step 5: Either: Mirtazepine 15mg nocte if symptoms seem anxiety-driven or if sleep disturbance
is a major issue
Or: time limited course of risperidone, 0.5mg nocte increasing if needed to 0.5mg bd 3-6 weeks,
after discussing risks with patient and/or carer. (See information sheet below for carers/care
home).

Step 6: If symptoms reappear when risperidone stopped or if otherwise needed, refer to

secondary care.

Notes
Memantine: Guidance in the Shared Care Guideline here: CCG Live - Specialist Drug Traffic Light
List

An information sheet about antipsychotic drugs in dementia for patients, families and care homes
is on the following pages.

Author: N Ardagh-Walter, 2gether NHSFT Drugs and therapeutics Committee , January 2016. Review date: January 2018
 Antipsychotics and Dementia

What are antipsychotics?

Antipsychotics are a group of medicines. They are often used for people who
have mental illness, and have unusual thoughts and experiences.

Antipsychotics are also used in people with Dementia who have extreme
anxiety and agitation. We should use antipsychotics in Dementia only when
all other medical and non-medical approaches have either failed or are not
suitable.

How do antipsychotics work?

Antipsychotics affect the action of chemicals in the brain which brain cells
need to talk with each other. Antipsychotics control the symptoms, but do not
get rid of them.

Why are antipsychotics used in Dementia?

People with dementia can have periods of agitation, restlessness, and

aggression. They may also have unusual thoughts and experiences.

Medicine trials have shown that antipsychotics can have a small but positive
effect on these symptoms. They can help the patient feel calmer, without
making him/ her feel slowed down or drowsy.

These effects are usually seen when antipsychotics are taken for a period of
6 - 12 weeks.
 What are the common side-effects of antipsychotics?

 Dry mouth
 Constipation
 Tremor and stiffness
 Increased risk of falls
 Interference with sex life
 Sleepiness and slowness
 Increased risk of stroke and mini-stroke (TIA)

Also, antipsychotics can sometimes increase the rate of decline of dementia.

Risks

If 1000 people with

Dementia take an
antipsychotic for around
12 weeks

Up to 200 patients About 17 will suffer

About 10 people will
may show from side effects
die due to the
improvement in such as stroke and antipsychotic

The risks are reduced if antipsychotics are used in low doses and for short
span of time.

For further information please contact:

Managing Memory 2gether: 0800 6948800