Minding Our Elders: Dementia aggression difficult to control

DEAR CAROL: My 79-year-old mother is on medication for aggression due to her dementia, but she still has periodic violent outbursts where she kicks and hits me. Her psychiatrist has tried several drugs in small doses to avoid side effects, but most of them leave her sleepy and have had little positive effect. Zyprexa has helped her the most, but that only means the outbursts have been cut in half. We haven’t found any specific triggers. Her physical aggression is wearing me out and I’m tired of this medication rollercoaster that’s been going on for three years. Am I expecting too much from these drugs? – Jeannine

DEAR JEANNINE: It’s likely that someday a physician will be able to order a blood test which will identify the exact medication needed to balance a person’s brain chemistry. Unfortunately, we are a long way from that ideal. Your mother’s doctor is trying his or her best to find a medication that will help, but considering your mother’s age as well as any possible health issues she may have, finding the optimum medication is difficult.

Zyprexa (olanzapine) is an atypical antipsychotic medication. Exactly how it works isn’t known, though it’s thought to work by changing the actions of certain chemicals in the brain. The drug is generally used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression), but doctors can use it for other illnesses if they think it may help the patient. Many doctors use atypical antipsychotic medications for dementia symptoms with varying results. Sleepiness is one of the most common side effects.

It sounds like your mother’s physician is diligent about trying to find a drug that will improve her behavior without over-medicating her. This isn’t an easy task. With any medication, side effects are almost guaranteed, so physicians often have to balance positive results against potentially negative side effects. It’s very common for people with your mother’s symptoms to require several medication changes before positive results are achieved.

You may want to ask the doctor if the negative effects of Zyprexa will ease over time. If that’s the case, the physician may be able to increase your mom’s dosage in the future. I’d suggest that you keep a careful record regarding how your mother responds to medications, the side effects you observe and how often she has episodes of aggression. This will help the physician decide what medication dosage is best for her.

Your mother’s behavior would be difficult for anyone to handle alone. You may need to consider in-home caregiving help or a good nursing home. You’d still be her caregiver, but you’d be part of a team. With people to help with your mother’s medication management and aggression issues, you’d be able to focus more on your personal relationship with her. Remember that you need to consider your own health as well as your mother’s.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

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