Alzheimer's Society welcomes neuroleptics ruling

Professor Clive Ballard, Alzheimer's Society director of research, says:

'The Alzheimer's Society sees this as an important opportunity to improve the treatment of people with dementia.

People with dementia are too frequently given powerful sedative and antipsychotic drugs. The Alzheimer's Society is concerned about the overuse of neuroleptic drugs, particularly in residential and nursing homes, where in some areas of the country more than 40 per cent of residents with dementia are prescribed these treatments.

The Society believes that sedation is not the answer and encourages initiatives to help further develop the skills of care staff to enable them to effectively interact and provide psychological treatments to better support people with dementia.'

The CSM has decided that the neuroleptic drugs risperidone and olanzapine should not be used for the treatment of behavioural symptoms in people with dementia and in older people who have experienced stroke or are at risk of stroke.

Evidence from a number of placebo-controlled studies of risperidone for the treatment of agitation in people with dementia has shown that people are three times more likely to have a stroke if prescribed risperidone. There is less information available for olanzapine, but the risk appears to be similar.

Neuroleptics such as risperidone and olanzapine are sedative drugs that are useful for treating schizophrenia, but have also been used widely to treat behavioural symptoms in people with dementia. In this context they have only modest short-term effectiveness and can have many undesirable side effects.

'Drugs are often prescribed instead of attempting to understand or investigate the cause of behaviour - for example, distress, feelings of humiliation or fear. Evidence suggests that training health and social care staff improves their understanding of communication problems and reduces the need to use neuroleptics,'

says Professor Clive Ballard.

The Alzheimer's Society contributed to the CSM guidance around this decision which will be circulated to all doctors and all nursing homes in the UK. The Society has also produced information sheets for people with dementia and their carers, and for care staff which provide more information about the CSM decision. For copies please call 0845 300 0336 or visit http://www.alzheimers.org.uk/.

Anonymous case study

Joan's mother developed Alzheimer's disease in 2001 and moved into a residential home. Here Joan's mother was put on neuroleptic drugs by a consultant psychiatrist to help ease her anxiety caused by Alzheimer's.

'It totally knocked my Mum out, to the extent that she had to be fed. It was totally appalling to see my mother reduced to this state.

'During the summer of 2002, Mum was admitted to hospital with a liver abscess. She was extremely ill. As she was so heavily sedated it was difficult for her to explain what was wrong or how she was feeling. By the time Mum came out of hospital the dementia had got a lot worse and she was put on another neuroleptic, called haloperidol, as her anxiety and confusion were often intense. This produced Parkinson's-like symptoms and her limbs were stiff. She was like a zombie most of the time. It was very distressing.'

In 2002 Joan mother was moved to another nursing home. With this move came a new care team, one that had a better knowledge of the drugs used to treat dementia.

'Mum's drugs were changed and she was put on a different, short acting anti-anxiety drug, which did not sedate her but did help her with her anxiety. She was also put on the anti-Alzheimer's drug Aricept. Mum was like the 'old' Mum again and her personality shone through.

'I think there needs to be more training for care staff to spot the signs of over sedation. There should also be training for doctors and care home managers on the benefits of anti-dementia drugs and on how to listen to the opinions of relatives. It was purely by coincidence that my Mum's drugs were changed.'

Notes for editors

• The Alzheimer's Society is the UK's leading care and research charity for people with dementia and their carers and celebrates its 25th anniversary in 2004.
• Over 750,000 people in the UK have dementia. More than half have Alzheimer's disease.
• Dementia affects one in 20 people over the age of 65 and one in five over the age of 80.
• There are 18,500 people in the UK under the age of 65 with dementia For information and advice on Alzheimer's disease or other forms of dementia call the Alzheimer's Society national helpline on 0845 300 0336.
• Our website address is: http://www.alzheimers.org.uk/.