The Effects of Behavioral Therapy on Alzheimer’s

Last Updated: March 6, 2019

A new study has concluded that behavioral therapy may be more effective in treating symptoms of Alzheimer’s disease than commonly prescribed antipsychotic medications.The Effects of Behavioral Therapy on Alzheimer's

Learn more about the study, the benefits of behavioral therapy and the risks of antipsychotic medication for people with Alzheimer’s.

Antipsychotic Medication vs. Behavioral Therapy

As most Alzheimer’s caregivers know, the disease is more than just losing memory. Aggressive behaviors, agitation and anxiety are a few of the symptoms that affect many people with the disease. These symptoms are most commonly treated with antipsychotic drugs. In fact, according to a recent report from the Government Accountability Office, 33% of people with Alzheimer’s in nursing homes are prescribed antipsychotic medication.

A new study published in the British Medical Journal challenged the widespread use of antipsychotic medication for Alzheimer’s by concluding that antipsychotics are less effective than non-drug treatments when it comes to managing symptoms of the disease.

Researchers observed over 20 years of studies and concluded that Alzheimer’s symptoms were best managed when caregivers were properly trained on how to communicate with and engage the person living with the disease.

While acknowledging that medication can be necessary for emergency situations, they found that antipsychotics were about half as effective as behavioral therapy techniques and that their use can have deadly side effects that increase over time.

The United States Food and Drug Administration (FDA) agrees and has issued a warning cautioning that antipsychotics can increase the risk of mortality for people with Alzheimer’s.

Long-Term Use of Antipsychotics: More Common in People With Alzheimer’s

Recently, another study from the University of Eastern Finland has added to the growing body of evidence suggesting that antipsychotic medication may be harmful to people with Alzheimer’s.

According to the Finnish Current Care Guidelines, use of antipsychotic medication for people with Alzheimer’s should be a short-term treatment option only for those with severe aggression, agitation or psychotic symptoms. Researchers found that antipsychotic drugs were being used 2-3 years prior to an Alzheimer’s diagnosis and were most commonly prescribed six months following an official diagnosis.

The study’s results were published in the British Journal of Psychiatry and concluded that 1/3 of people with Alzheimer’s were using antipsychotics, a rate five times higher than the control group, who did not have the disease. Researchers evaluated over 7,200 people with Alzheimer’s using antipsychotics and found that 57% of the participants were using the drugs long-term, for over a year.

The researchers also note that the risk of using antipsychotics could do more harm than good in people with Alzheimer’s.

Professor Sirpa Hartikainen cautions that “In Finland, the present incidence of antipsychotic use and the duration of antipsychotic treatment are not in line with the treatment guidelines. This is a cause of concern because the use of antipsychotics increases the risk of severe adverse incidents.”

Using Behavioral Therapy as a Long-Term Solution for Alzheimer’s Symptoms

Dr. Helen Kales, director of the University of Michigan’s Program for Positive Aging, said of these study results:

“Why I think the caregiver interventions work is because they train caregivers to look for the triggers of the symptoms. When [caregivers] see the triggers of the symptoms, they train them to manage them… It’s inherently caregiver and patient-centered.”

She also spoke about the risk of mortality associated with antipsychotic drugs, stating that the risk is small over the short term but increases the longer the drug is used.

More research into the effects of behavioral therapy on Alzheimer’s is being carried out, specifically on cognitive behavioral therapy (CBT).

CBT is a talking therapy that helps people understand the often missing link between actions, feelings and thoughts, and then use that understanding to make positive changes in their life. Over time, it has become a popular way of helping people cope with mental health problems including anxiety and depression.

Dr. Josh Stott is a researcher from the University College London and is investigating whether this type of therapy could help people in the early stages of the disease, who often struggle with anxiety and depression.

He says that CBT would only be helpful for individuals who have Alzheimer’s and anxiety or depression and that it would be more helpful in the early stages of the disease when cognition is not as impaired.

While this study is still ongoing, researchers are hopeful that CBT will have positive outcomes for people with Alzheimer’s, helping them to better manage the symptoms that often accompany the disease.

Have you seen the positive effects of behavioral therapy on a loved one with Alzheimer’s? What was your experience like? We’d like to hear your stories in the comments below.

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Please leave your thoughts and comments

  • peggyutsler

    So many nursing homes would rather keep them sedated so as not to be bothered. Please, compassion is so desired, perhaps if you hang pictures of them in their younger days they may be viewed as a person rather then just a job.

  • ben blue

    my wife was given strong Meds as soon as she was told she had Alzheimer’s .she was gat worse .she was a lot better before the strong Meds now she is in stage 6 and some into 7 . I have ben her only caretaker for 7years. I Think the caregiver intervention works very well for I
    have ben using a lot of triggers of symptoms ,as well as I love you when she gets feisty.and takings for a ride will bring her back. to a better state of mind sort of speak and for a while. I wish I had the good advice before she got so bad .But after 45 years of marriage I God willing I will Keep going as long as I can. thanks for any and all help H L B

  • nursecathy123cat

    Antipsychotics have Black Box warnings of the serious side effects possible for people who take the medication and who have dementia. Another commenter here is correct–it is easier, in the short term, to give a pill and sedate the resident. But spending time and interacting with the person is a better long-term technique. It takes a little more time up front but is both safer and has better results. Owners of long-term care facilities must realize that having enough care staff is essential.

  • Melyssa A. Harmon

    I believe pain is a large contributor to behaviors seen in dementia and memory care residents. Behavioral therapies via trained caregivers, coupled with basic pain management, and the need for psychotropics goes down. Keeping breakthrough pain at bay while providing psychosocial activity as a means of therapeutic intervention speaks volumes to a person living with purpose vs yesteryear sedation. Getting communities to sign on to this is coming around thanks to regulations and innovative health care professionals that understand that it begins with our front line staff.

  • Judith Wank

    Of course, behavioral interventions can be effective and less damaging. But as a retired Alz. Assn. Assistant Director and current support group facilitator, we must also recognize that most caregivers are exhausted, on medications themselves, have financial considerations and strong other physical handicaps themselves. They may not have the emotional resources necessary to even begin to implement behavioral therapies.

    My own husband recently died from Parkinson’s. Even with 24 hour live in aide, when psychosis hit, we were unable to manage. I knew I could deal with Parkinson’s, and with dementia if it came, but was unprepared for the challenge of psychosis. And with physical challenges of my own, unable to continue. True for many of my caregivers.

    Sometimes, professionals neglect to include the issues of the caregiver which may preclude the ability to handle the time and effort required to utilize behavioral interventions. They are exhausted both physically and emotionally. So despite the risks of pharmaceuticals (consider what caregivers are taking just to survive from day to day), it often becomes the only way to stave off placement of whatever sort is affordable.

  • Valentin Bragin

    The behavioral interventions could be used separately, or in the combination with medications. Medications help to modify patient’s behavior, to regain self-control and to decrease caregiver’s stress. Non verbal communications (posture, touch, tone of voice, facial expression, gestures, and eye contact), and any kind of joint activities (singing, walking, reading, storytelling) increase communications between the patient and caregiver.

  • Mary

    The most effective behavioral intervention I have used and trained my staff on is to treat the residents with the same dignity and respect you would want to be treated with. No “baby talk; no calling residents honey, dear, or sweetheart; acknowledge all the emotions a person experiences; and provide them the opportunity to have a voice in their own lives. People will forget what you say, they will forget what you do, but they never forget the way you make them feel.

    • caitlinburm

      Mary,

      Thank you for sharing such incredible insight and advice with us.

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