This will be a busy week for Alzheimer’s and dementia news. The Alzheimer’s Association’s 2016 International Conference (AAIC) is being held in Toronto. It is always a rich news week for those of us who depend on the conference to highlight the latest and most promising research.
In the news today was some exciting research which validates something that many of us in the dementia care world have known for years. That the use of antipsychotic medications to reduce behavioral and psychological symptoms of dementia (BPSD) is not very effective and what we should be doing instead is focusing on meeting the unmet needs of the person living with dementia through person centered approaches.
The highlight of today’s news from the conference was research conducted by Australian researchers who presented results from a research project where they dramatically reduced the use of antipsychotic medicines to treat the Behavioral and Psychological Symptoms of Dementia (BPSD).
“The Halting Antipsychotic use in Long Term care (HALT) Project, based in New South Wales, Australia, successfully eliminated regular antipsychotic medication from the treatment plan in 75 percent of study participants after 6 months following initial reduction of antipsychotics (12 month follow up data to come). In this study — which involved 140 residents across 23 care facilities — deprescribing was achieved through training of long-term care facility nurses in non-pharmacological and person-centered approaches to managing BPSD.”
Click here to read the full press release and many others from the conference.
There’s a new word we need to add to our lexicon about Alzheimer’s and dementia care, “deprescribing”. In my experience, it is not so much the training of the nurses to use a non-pharmacological/person centered approach, although we at Brookdale believe strongly in this training and that it is a very important ingredient in all good dementia care. In my opinion, it is also important for us as a society to start questioning the culture that supports these drugs being in the picture in the first place.
The researchers are quoted in the press release as saying:
“Deprescribing of antipsychotics in long-term care residents with previous BPSD is feasible without reemergence of BPSD; however, challenges still exist regarding sustainability and culture of prescribing in aged care,” said Henry Brodaty, MD, DSc, of the Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia. Brodaty added, “Often there can be cultural and logistical barriers to moving away from antipsychotics in aged care settings, but we hope the results of this project will serve as a positive example towards a more person-centered approach globally.”
Ah, so there it is. All we have to do is change the culture. Not so easy right? Well maybe we need to start by looking at dementia differently. In order to begin to remove the barriers the researchers identified and have the person centered/non-pharmacological approaches (what works) become the norm, we must transition away from always viewing dementia through a biomedical lens. There are many of us who now clearly recognize that the more humane and sane way to view dementia is through a bio-psychosocial-spiritual lens. A person centered view that puts the person living with the disease at the center. So, why does this continue to be such a struggle?
Also in the news this week was an article in the NY Times that highlighted another release from the AAIC conference. This one involved a proposal presented at the conference by a group of neuropsychiatrists and Alzheimer’s experts that calls for a new diagnosis of Mild Behavioral Impairment (MBI). A companion to Mild Cognitive Impairment (MCI), it is thought that “the idea is to recognize and measure something that some experts say is often overlooked: Sharp changes in mood and behavior may precede the memory and thinking problems of dementia.”
The article goes on to make the case that this new diagnosis (MBI) would enable physicians to more readily diagnose early behavioral symptoms as another measure of who may be starting down the path of Alzheimer’s–all in the name of good treatment getting started. And, although they do not say it explicitly, I wonder how long after this new diagnosis hits the books will it be before we see the TV commercials for the new MBI drug.
So, the struggle continues. We know what works is viewing dementia differently, but we continue to use the wrong and frankly out of focus, lens. The NYT article uses the example of a woman’s drastic behavior changes as a recognizable early sign of her later diagnosis of Frontotemporal dementia (FTD). Clearly this is a different situation than someone who is unusually short tempered because they are experiencing frustration with new memory loss. Why would they both carry the same diagnosis? Does the second scenario truly warrant a diagnosis and as the article suggests, the upside of “…medications which help manage mood and behavior”? Or do people living with early dementia symptoms simply need our support and understanding?
What if with the labeling of BPSD and now MBI we have only served to pathologize and medicalize a person’s normal human responses of fear, frustration, anxiety, anger, resistance, denial, unhappiness, depression, etc. to the cognitive changes that they are experiencing? Might we get farther with person centered approaches being the norm if we move to embrace a culture of understanding that it is perfectly normal for someone to have an emotional response to the cognitive changes that accompany dementia at every stage?
To read more about person centered non-pharmacological approaches to dementia care see these websites: