Before resorting to drugs, try some simpler strategies

Even for people with dementia, antipsychotic drugs are often used only as a last resort.

Some behavioral extremes can be eased with environmental changes. For example, a frail elderly person who flies into a terrified rage when glimpsing a “stranger” in the mirror can be calmed simply by removing the mirror, says Debra Cherry, the associate executive director of the California Council of the Alzheimer’s Assn.

Others can be addressed by identifying any existing medical problems. A urinary tract infection, for example, can be impossible for many elderly people with dementia to describe, but the discomfort can make them agitated and angry.

Caregivers should also ensure that the elderly person has a regular sleep cycle and a highly predictable daily routine.

Exercise has been shown to be an effective way to manage some of the behavioral symptoms of dementia. In a study published last month in the Annals of Internal Medicine, researchers at the Group Health Cooperative in Seattle found that regular exercise reduced the risk of dementia and Alzheimer’s disease. It also reduced forgetfulness after the onset.

But, as lead investigator Eric Larson explained in an e-mail, “This study didn’t address exercise in the setting of management of behavioral symptoms.”

An earlier study by the same group, published in JAMA in 2003, did focus on behavioral symptoms. It found that a home-based exercise program, in which caregivers assisted patients with moderate exercise for only an hour a week, reduced some behavioral symptoms of those afflicted with dementia.

Clinicians recommend that when agitation becomes severe, caregivers begin a soothing or repetitive activity -- hair brushing, for example, or a massage or manicure. And, in a lesson learned from children, distraction with a snack or a video can often calm an elderly person and offer a caregiver a sense of control.

But environmental approaches frequently are unable to keep pace with the constantly shifting and accelerating confusions and terrors of the elderly. Then families and caregivers must cope with the intricate management of medication.