Useful article link for background reading in the use of Risperidone in Dementia in the Frontiers of Pharmacology. Risperidone & Dementia in this article you will come up with term EPS and so this is what is means ExtraPyrimidal Symptoms that is the drugs can induced involuntary movements.
The research team at Brunel University have teamed up with Sheffield University to look at risk factors in the use of Risperidone in Dementia. The prime worry is that it can cause stroke. So there is a need to look at those that are already at risk of stroke before adding to this risk factor. If you look at the active link to a useful article I have put in this post you will read how this drug has been a drug of choice to help calm patients that have become agitated & may also have some aggressive behaviour. You will read how this can be a problem in dementia but there are also non pharmaceutical ways to care plan as we know perception and interpretation of the environment and situation can change.
Here is a link to look at recognition of Dementia & Alzhiemer's Disease I remember a talk at our local library on Alzhiemer's and the library itself was a good analogy used. Look at the shelves of books and see these as memories, learning and experiences filed away in your brain. Now imagine someone knocking those shelves and some books fall away and some stay. Some memories are still stored and some lost. Some known perceptions of surroundings changed as the information lost. So a dark round circle of pattern on a rug may be seen as a deep pool of water and so the patient holds back and is fearful of stepping forward. The nurse or carer will be seeing no danger but the patients is seeing danger. This may lead to agitation but an agitation understood if you see this analogy. So developing surroundings to minimise such extreme misinterpretations is needed.
In our sharing at the meeting we also identified that agitation may in fact be due to physiological conditions such as constipation and ureamia from lack of fluids or reduced intake. Hence why in a nursing care plan we need to be sure we monitor daily physiological needs and actions. Basic health care nutrition is vital to reduce the incidence of agitation. We also identified that staffing levels in nursing homes, residential homes and care of elderly wards need to be such as to spend time with patients to understand individual needs and preferences. As I write this I am thinking back to a dear Indian friend that was hospitalised in ITU it was so upsetting seeing her in her hospital open back gown and it felt therapeutic for me and I feel for her to drape a dupattia around her .. the loose scarf worn with sarwaar chemise. I too think of what I would like in my vulnerability to have something of my identity to feel a link to the "ME!" that I may be losing. In fact this BORG is brilliant now for me to link to me and my experience as a nurse and midwife.
So now to think on this side effect worry of stroke when using Risperidone. We has a group wished to know why is there this increased risk. If raises BP to cause a stroke then what is there in the patients past medical history that is an alert. I keep bringing to the researchers the need to identify if there is a history of Sleep apnoeas and the need for CPAP. But this is problematic as there are unknown diagnosis in the population that have sleep apnoeas and thus do not have CPAP treatment. There is a further thought in me as if this is so, could prolonged incidences of low oxygen sats have led to the dementia? I tied in with last weeks look at long covid and incidence of dementia. Do we have the data on the low oxygen sats and was this the causative factor?
One group member was putting forward that if the drug causes high BP can we not counter this with an anti hypertensive? Another asked well what effect does it have on the dementia does it improve the condition to warrant the use of this drug or is it solely to calm agitation?
I am trying to read round why the drug causes high blood pressure does it affect the angiotension renal regulation or is it that it vasa constricts. We have a duality here as if to calm agitation then surely it would lower blood pressure with the sedative effect. There is some lay literature discussing high blood pressure effect in first days of administration but also standing drop in blood pressure to incur risk of falls.. So I am looking forward to learning more on the exact mechanism of the drug.
