It is increasingly recognized that pharmacological treatments for dementia should be used as a second-line approach and that non-pharmacological options should, in best practice, be pursued first (Douglas, James, & Ballard, 2014).

Specific medications have specific black box or beers criteria warnings for use with other adults (e.g., antipsychotic medications). However, these medications continue to be first-line, despite clear and substantial risks to patient health.

Per Alves et al., 2013, behavioral symptoms such as repetitive statements and questions, wandering, and sleep disturbances are a core clinical feature of Alzheimer disease and related dementias, affecting patients and their families. These behaviors have devastating effects. If untreated, they can contribute to more rapid disease progression, earlier nursing home placement, worse quality of life, accelerated functional decline, greater caregiver distress, and higher health care utilization and costs.

It is important to include on-going systematic screening for behavioral symptoms to facilitate prevention and early treatment as part of standard comprehensive dementia care. Because available pharmacologic treatments used to treat behaviors have modest efficacy at best, are associated with notable risks, and do not address behaviors most distressing for families, non-pharmacologic options are recommended as first-line treatments or if necessary, in parallel with pharmacologic or other treatment options. Non-pharmacologic treatments may include a general approach (caregiver education and training in problem solving, communication and task simplification skills, patient exercise, and/or activity programs), or a targeted approach in which precipitating conditions of a specific behavior are identified and modified.

These are all examples of the evidence based services I offer.