From the Guidelines
Lo spine is not a recognized medical treatment for Behavioral and Psychological Symptoms of Dementia (BPSD). For managing BPSD, a stepped approach is recommended, starting with non-pharmacological interventions before considering medications, as suggested by the most recent guidelines 1. Non-pharmacological approaches include:
- Identifying and addressing underlying causes (pain, infection, constipation)
- Environmental modifications
- Caregiver education
- Structured activities
If medications are necessary, they should be targeted to specific symptoms. The Canadian Coalition for Seniors’ Mental Health has issued detailed guidelines for managing behavioral symptoms of dementia, which can be referred to for specific recommendations on pharmacological management 1.
It's essential to note that antipsychotics, such as risperidone or quetiapine, carry black box warnings for increased mortality in elderly patients with dementia and should be used cautiously. The goal is to use the lowest effective dose for the shortest duration necessary while continuing non-pharmacological approaches.
In terms of specific medications, the evidence is limited, and the choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as recommended by previous guidelines 1. However, these guidelines are outdated, and the most recent recommendation prioritizes non-pharmacological strategies 1.
Therefore, the primary approach to managing BPSD should focus on non-pharmacological interventions, with medications considered only when necessary and with careful monitoring of their effectiveness and side effects.
From the FDA Drug Label
WARNINGS AND PRECAUTIONS SECTION 5. 1 Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. RISPERIDONE (risperidone) is not approved for the treatment of dementia-related psychosis [see Boxed Warning].
The FDA drug label does not answer the question about using Lo spine to treat BPSD.
From the Research
Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)
- The management of BPSD is highly individualized and requires a thorough assessment of the patient's condition 2.
- Non-pharmacological interventions, such as training of formal caregivers, are considered the most effective approach for managing BPSD 2, 3.
- Pharmacological interventions, including antidepressants and antipsychotics, may be used to treat BPSD, but their use should be limited due to the risk of adverse events 2, 3, 4.
- Specific medications, such as olanzapine and risperidone, have been shown to be effective in reducing BPSD, but their use should be carefully considered due to potential side effects 5.
Non-Pharmacological Interventions
- Functional analysis-based interventions have been shown to be effective in reducing BPSD 3.
- Music therapy may also be beneficial, but further research is needed to confirm its effectiveness 3.
- Assessment of pain and a stepped analgesic approach may be helpful in managing BPSD 3.
Pharmacological Interventions
- Antipsychotics, such as olanzapine and risperidone, have been shown to be effective in reducing BPSD, but their use should be limited due to the risk of adverse events 2, 3, 5, 4.
- Cholinesterase inhibitors, such as donepezil and galantamine, may be used to manage BPSD, but their effectiveness is limited 3.
- The use of medications, such as stimulants, cognitive enhancers, and benzodiazepines, is not supported by strong evidence and should be avoided whenever possible 2.