Cer­tain medicines bad for de­men­tia suf­fer­ers

The Star Early Edition - - HEALTH -

THOU­SANDS of peo­ple in the UK with a com­monly mis­di­ag­nosed form of de­men­tia are at in­creased risk of in­jury or death be­cause they are be­ing pre­scribed po­ten­tially harm­ful anti-psy­chotic med­i­ca­tion, ex­perts have warned.

The symp­toms of Lewy body de­men­tia in­clude hal­lu­ci­na­tions, mo­tor prob­lems, faint­ing spells and dis­turbed sleep in which peo­ple ap­pear to “act out” their dreams, as well as the cog­ni­tive de­cline as­so­ci­ated with other forms of the dis­ease.

De­men­tia with Lewy bod­ies is the sec­ond most com­mon form of the dis­ease af­ter Alzheimer’s and is es­ti­mated to ac­count for about 15% of all de­men­tia cases.

How­ever, up to 60 000 peo­ple in Bri­tain may be un­aware they have the con­di­tion, which is missed or mis­di­ag­nosed in up to 50% of cases, said Pro­fes­sor Clive Bal­lard, a lead­ing re­searcher of the dis­ease at the Univer­sity of Ex­eter.

Anti-psy­chotic drugs given to de­men­tia suf­fer­ers to treat be­havioural dis­tur­bances have been found to in­crease the risk of death for peo­ple with Lewy body de­men­tia four­fold, com­pared to one-anda-half times in peo­ple with Alzheimer’s dis­ease, he warned.

These medicines, pre­scribed to about 15% of peo­ple with de­men­tia over­all, can worsen symp­toms of Parkin­son’s dis­ease com­monly seen in Lewy body de­men­tia suf­fer­ers, lead­ing to risky falls.

They can also trig­ger a po­ten­tially fa­tal syn­drome known as a “neu­ro­lap­tic sen­si­tiv­ity reaction”, de­scribed by Bal­lard as “a very acute syn­drome which can come on within one or two hours of tak­ing an anti-psy­chotic drug, or in­creas­ing the dose”.

“When peo­ple have these re­ac­tions they de­velop very se­vere Parkin­son’s symp­toms and be­come very con­fused. You also get a break­down of muscle cells which can lead to re­nal fail­ure; there’s quite a high mor­tal­ity rate acutely as­so­ci­ated to these re­ac­tions.”

Bal­lard said about a quar­ter of peo­ple di­ag­nosed with Lewy body de­men­tia would have such a reaction when given the wrong med­i­ca­tion.

Even if peo­ple do not die as a re­sult of the syn­drome, they may ex­pe­ri­ence a steep de­cline in their con­di­tion “which they usu­ally do not re­cover from”, he added.

A new set of di­ag­no­sis guide­lines have been in­tro­duced by the De­men­tia with Lewy Bod­ies con­sor­tium in the hope that bet­ter di­ag­no­sis rates will re­duce the risk of pa­tients be­ing given drugs that may harm them.

“Get­ting the di­ag­no­sis right is very im­por­tant, par­tic­u­larly for the treat­ment of the psy­chi­atric symp­toms those peo­ple may have,” said Bal­lard.

Along with other forms of de­men­tia, there is cur­rently no cure for Lewy body de­men­tia, which ac­tor Robin Wil­liams suf­fered from be­fore his death in 2014, said his wi­dow Su­san Wil­liams.

“In ad­di­tion to the de­men­tia and the cog­ni­tive de­cline, and prob­lems with ev­ery­day liv­ing and func­tion, peo­ple are very prone to psy­chi­atric symp­toms, par­tic­u­larly visual hal­lu­ci­na­tions, see­ing things that aren’t there,” said Bal­lard.

“Those symp­toms usu­ally oc­cur in the later stages of Alzheimer’s dis­ease, for about an hour a week, while in Lewy bod­ies, it’s there from an early stage of the dis­ease.

“They’re very per­sis­tent, and it can be up to five hours a day.

“They’re very dis­tress­ing. Sus­pi­cious ideas and para­noia are very com­mon, de­pres­sion is very com­mon as is anx­i­ety, with sub­tle symp­toms of Parkin­son’s dis­ease as well, ” he said. – The In­de­pen­dent

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