Dementia in Head Injury
Medications for Dementia After a Head Injury continued...
These drugs increase the amount of a brain chemical (neurotransmitter) called dopamine, which may improve concentration, attention, and interest level in people who have sustained a head injury.
Dopamine enhancers may interact with antidepressants to improve mood swings.
The most potent of these drugs is levodopa, but it also causes the most side effects. Other drugs include bromocriptine (Parlodel) and the stimulant dextroamphetamine (Dexedrine), which increases levels of dopamine and another neurotransmitter called norepinephrine.
These drugs are used to treat psychotic symptoms such as delusions, hallucinations, agitation, and disorganized thinking and behavior.
Traditional antipsychotic drugs work well at relieving psychotic symptoms, but are more likely to have side effects that may worsen cognitive function. These include haloperidol (Haldol).
Newer antipsychotic drugs (such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) may be better tolerated. These drugs may work particularly well for the agitation and other psychotic symptoms common in head-injured persons.
Keep in mind that all antipsychotic drugs carry a "boxed" FDA warning describing an increased risk of death from all causes when given to elderly patients with dementia-related psychosis. When prescribed, they must be administered cautiously and with the informed consent of individuals who are designated to make health care decisions if the patient himself cannot. In addition, antipsychotic drugs can lower the seizure threshhold and therefore must be used cautiously if there is concern about seizure risk following a head injury.
These drugs often work well in behavior disturbances (aggression, agitation) that occur as complications of head injury. They can be helpful to treat impulsive or aggressive behavior and sometimes help with moment-to-moment changes in mood. Examples include carbamazepine (Tegretol) and valproic acid (Depacon, Depakene, Depakote).
Like some antiepileptic drugs, the drug lithium (Eskalith, Lithobid) is a mood stabilizer. It is helpful in calming explosive and violent behavior. Lithium also decreases impulsive and aggressive behavior.
These drugs are sometimes used cautiously to quickly relieve agitation or violence on a short-term basis in people with dementia. They have other uses, such as treating insomnia and relieving anxiety. However, they can worsen cognitive and behavioral problems (e.g., impulse control) in people with head trauma and are therefore generally not recommended in head-injured persons with dementia, except when needed to calm a person rapidly. Examples are Ativan (lorazepam) and Valium (diazepam).
These drugs work well in treating aggression in some people with head injury. They also reduce restlessness and agitation. An example of these drugs, which are most widely used to lower high blood pressure, is propranolol (Inderal).