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Treatment of Behavioral Symptoms: When to Consider Antipsychotic Medications in LBD - Page 6

Answers to Frequently Asked Questions

It seems that my mother’s hallucinations are worse when she has not slept well. What can I do?

It is not your imagination. Lack of sleep may increase confusion and behavioral problems in people with LBD. Sleep problems including sleep apnea, restless leg syndrome and REM sleep behavior disorder are common in LBD. These sleep problems can keep the person with LBD and his or her caregiver from getting sleep.

Often, these sleep problems can be improved without medications.  Increasing daytime activities and avoiding naps (one benefit of senior activity centers) can promote better sleep.  In addition, people with dementia should not consume alcohol, caffeine, chocolate or coffee late in the day. Some over-the-counter medications can also affect sleep, these should be reviewed with your mother’s physician.

If these non-medication interventions fail to work you may want to ask your mother’s physician about what can be done to treat her sleep problems. The doctor may recommend a prescription medication to help your mother sleep at night.

My husband’s doctor wants him to start taking a drug called memantine. Will this affect his behavioral symptoms?

Memantine (brand name Namenda) acts by blocking a brain chemical called glutamate, which appears to be overactive in the brains of people with dementia. By blocking the glutamate, memantine may help to improve cognitive function.  Memantine has a slightly different method of action than cholinesterase inhibitors, so both medications can be used at the same time.

Memantine was approved for use in the United States in 2003 and there have several studies reporting its use in people with LBD. The most recent research shows memantine may be beneficial to some people with LBD, particularly for problematic behaviors. If your husband is not taking a cholinesterase inhibitor, you should try these medications first. If he is already on a cholinesterase inhibitor, your husband’s physician may suggest a trial of mematine. As with all new medications, you will need to monitor your husband closely and notify his physician if behavioral symptoms worsen.

During a respite stay at a local nursing facility, my wife was given diazepam to calm her down and help her sleep. When I returned she was in terrible shape – alternating between being highly agitated and almost unresponsive. What happened?

Like many medications, benzodiazepines like diazepam (brand name Valium) affect people with LBD differently than younger people without dementia. Benzodiazepines are sedating, but someone with LBD may actually experience this ‘paradoxical effect’ of alternating sedation and agitation. 

Before you schedule another respite stay for your wife, try to find an assisted living or nursing facility that specializes in dementia care. Also, make sure that the physician who normally cares for your wife’s LBD is in contact with the medical director of the respite facility. He or she can provide guidance to the facility staff on dealing with your wife’s sleep difficulties and behavioral problems.