Mailbox Response

The question was submitted 25 September 2009

Subject: Violence

How the handle a violence dementia patient? It is necesary to be warded to IMH? What are the best medication? Adding herbal remedy does it help?

Answer from DementiaNet

At times, persons with dementia may exibit agitated or aggression behaviour. One has to approach the situation to try de-escalate the situation. This usually involves approaching the person in a calm and reassuring manner to try to soothe him/her. At time, distraction technique may help. Do not try to reason or argue which could escalate the situation. Use the ABC method to ascertain the A (ie Antecedent) (B being the Behavior and C the Consequence). Sometimes, the antecedent could be physical problems (pain, constipation, hunger), environmental (noise, unfamiliar place, crowd), emotional/mental (depression, hallucination, delusion) etc. One can then reduce the violence by addressing the root cause(s). Very few needs to be admitted to a hospital, only in situation with prolonged aggression or if various methods failed.

There is no evidence that herbal remedy helps. However, Huperzine A , a naturally occurring compound found in the Chinese herb  Huperzia serrata,  is an Acetylcholinesterase inhibitor similar to other compounds donepezil , rivastigmine , and galantamine . The National Institute on Aging in US has completed a Phase II clinical trial to evaluate the safety and efficiency of huperzine A in the treatment of Alzheimer's disease in a randomized controlled trial of its effect on cognitive function. A systematic review of this compound (Fu & Li, 2009) concluded that it shows promise in the treatment of AD. However, the current evidence in support of their use is inconclusive or inadequate. So one should not rush to advicate its use without strong evidences that it really works.

The answer was published on DementiaNet 05 October 2009