Question

My father suffered a stroke 5 years ago with some minimal negative effects from it. A year later he had to have a coleostomy. He became extremely depressed and then began to show signs of Alzheimer's. This has progressed and he is behaviourally difficult. He has been prescribed medications for his problems, including a selective serotonin reuptake inhibitor, which proved very effective. However, he has now stopped taking this, despite the efforts of the family and his doctor to encourage him to continue. His behaviour has worsened again. How can he be persuaded to comply with his medication?

Answer

The situation you describe is a common problem in the treatment of dementia and certainly difficult to handle. During progression of dementia, a variety of behavioral disturbances may occur, including depression, agitation, aggressiveness, and delusions. In addition, difficult personality traits may worsen. In such cases, the caregiver and the doctor play a key role in convincing the patient to take the prescribed and necessary medication. However, the task is difficult and requires experience with dementia and behavioral symptoms, and also psychotherapeutic skills. A careful drug treatment may stabilize the patient and reduce the patient's suffering as well as the caregiver burden. In addition, such treatment may delay nursing home placement. The latter may be a central argument to convince the patient of the use of the treatments and to improve compliance. Obviously, the antidepressant Zoloft has shown some positive effects, suggesting that antidepressants from the class of serotonin reuptake inhibitors (SSRI) may improve the depressive spectrum of the disease. The patient's fear of high costs of his medical treatments are in obvious contrast to his good health plan. Sometimes such signs can be part of a spectrum of delusional ideas. If symptoms such as delusions, agitation, and aggressiveness predominate, then additional treatment with atypical neuroleptics, such as risperidone, or other substances from this class, may help.

Links

• Factsheets on care issues