Use of antipsychotic drugs declines in dementia treat-ment

Nurse Practitioner Amanda George, left, and Dr. Rimda Gupta, with Tennova Internal Medicine, encourage locals to learn about dementia and the effects of antipsychotic medications. Local medical professionals and the Tennessee Department of Health are working to improve care for those living with dementia by reducing the unnecessary use of antipsychotic medications.

Local medical professionals and the Tennessee Department of Health (TDH) are working to improve care for individuals living with dementia. An essential part of this effort is reducing unnecessary use of antipsychotic medications.

One way the results can be measured is by tracking the use of antipsychotic medications by nursing home residents diagnosed with dementia. Nursing homes in Tennessee have reduced antipsychotic medication use to a rate of 15.7 percent of residents.

That lower rate has moved up Tennessee from 49th to 29th in the nation for improvements in this area, according to TDH.

The use of antipsychotics has shrunk significantly, according to Dr. Rimda Gupta, with Tennova Internal Medicine.

“Optimizing the quality of dementia care means responsible use of antipsychotics,” Gupta said. “Toward this end, CMS National Partnership to Improving Dementia Care in Nursing Homes was started in 2012 to enhance the use of non-pharmacologic, person-centered treatment modalities.”

By 2016, Tennessee had seen a reduction of antipsychotics use from 43 to 5 percent, according to Gupta.


Learn about dementia

Dementia is a progressive decline in mental functions, said Amanda George, nurse practitioner with Tennova Internal Medicine.

“Dementia usually starts with slips in short-term memory and eventually steals the names of family members, the purpose of utensils and what year it is,” George said. “To the medical professional, dementia looks like de-evolution of a functioning adult, a sort of return to infancy.”

It is characterized by a loss of independent functioning, higher-level thinking, confidence and literacy, said George.

“To the loved one, dementia is a thief,” George said. “It feels like watching the dissipation of a loved one’s soul, right before our eyes, well before the body wears out.”

Dementia is “cold,” “heartbreaking” and “frustrating,” and it “can bring the entire family to its knees,” added George.


What are antipsychotic medications?

Antipsychotic medications were introduced in the United States in the 1950s, with the two main classes being typical and atypical antipsychotics, said George.

“At the time of development, they were exciting,” George said. “These meds, by nature, are intensely sedating, which was the very characteristic that made them ideal for employment as a sort of chemical restraint to agitated patients.”

But antipsychotics are also notorious for producing side effects, such as constant involuntary movements of the tongue, face or any other part of the body. Side effects also include muscle rigidity, tremors, stupor and fatal fevers, said George.

Additionally, those medications interact with a large number of common medications many people also need to take regularly, she added.

“Also, they do nothing to reverse the state of dementia or enhance the quality of life of the person suffering with dementia,” George said.


Reducing the use of antipsychotic medications

Antipsychotics are essentially chemical restraints, said George.

“They do nothing to enhance the quality of life of the person affected with dementia – only to subdue the frustrated, emotionally-charged outbursts that can come from being completely confused and scared,” she said.

“New medications are now available – medications that are able to do more than make someone lay down and be quiet – that improve mental function, lower blood pressure and balance mood.”


Touching many families

Alzheimer’s disease is the most common type of dementia. In 2014, 5 million people were living with Alzheimer’s disease in the United States, according to the Centers for Disease Control and Prevention (CDC).

“Dementia touches many families in this nation,” George said. “It tends to travel within families, from what I have seen. The older we get, the more likely we are to succumb to it; but family history and genetics usually play into that.”

A healthy lifestyle aids in decreasing the development of dementia, added George.

“Locally, we see a lot of patients,” George said. “We also see a lot of patients … with concerns for possibly developing dementia, and you can really see the fear.”

The good news is treatments have seen great improvement.

“Some newer medications really do a lot to help and improve the blood flow to the brain, lower blood pressure and to balance mood without chemically sedating the patient,” George said. “The newer meds work to enhance the quality of life in a way that the older medicines didn’t.”

While the new medicines can’t reverse the damage, they can slow the progression of dementia, and that’s why early treatment is important, said George.

“They can give patients and their families a good quality of life,” she said.

Elena Cawley may be reached at