Ketamine: Is it a Cure? Behaviors in Dementia

Ketamine: is it a cure? behaviors in dementia, ask for geriatric telemedicine consultations elderhealthathome.com, photo of a nurse with an elderly patient seated couch

No, unfortunately ketamine is not the cure for behavioral issues in dementia. There is no cure. However, while ketamine is not able to completely eliminate dementia behaviors it doesn’t mean that they can’t be managed with ketamine assisted psychotherapy. As with most things in life, managing behaviors is fluid and you will need a lot of tools in your toolbox. 

Neurocognitive Disorder / Dementia Symptoms That May be Addressed With Ketamine Therapy

As dementia progresses, it is likely that a person will experience:

  • depression
  • psychosis
  • agitation
  • aggression
  • apathy
  • sleep disturbances
  • disinhibition

These symptoms are what the medical community refers to as neuropsychiatric symptoms (NPS); what spouses, caregivers and loved ones refer to as “the end of my rope”. Despite the fact that 98% of people with dementia have these symptoms (regardless of dementia type) unmanageable behaviors are the culprit for most family members to institutionalize their loved ones.

Modern medicine does not have a one size fits all medication or treatment plan. This is because behaviors occur for a multitude of reasons and often require a multimodal approach. Ketamine lends itself to the multimodality concept because the drug itself is adaptable to individualize. 

Ketamine was FDA approved for use as an anesthetic in 1970 and is still used for this today. However, over the past 10 years research has demonstrated a variety of issues that can be treated with ketamine, including depression, anxiety and pain.

Ketamine is a unique medication in that its mechanism of action is difficult to understand and is likely multifactorial. The simplified version for how it is used in the behavioral concept is: it disrupts the routine pathways in the brain (interrupts the ruminating thought processes giving the brain the ability to see things in a different way or change focus.) This is not the scientific explanation, it is the opinion of the writer Micheal Pollen and based on his scientific research. 

A) brain of normal person -as you can see same repetitive thoughts that don’t really change from our normal routines B) A brain on ketamine -offers a variety of different thoughts, perspectives, views of life.
Image from the book: How to Change your Mind by Michael Pollen. The diagram shows a comparison of a) brain of normal person – as you can see same repetitive thoughts that don’t really change from our normal routines; and b) a brain on ketamine – offers a variety of different thoughts, perspectives, views of life.

Ketamine is short acting, meaning it only stays in one’s system for about 1 hour but the changes it can make in the brain can last weeks to months. Ketamine is a relatively safe medication, especially when used in low doses for someone with behavioral problems. The medication has many different administration methods such as oral, injection, IV, nasal and topical. At ElderHealth we commonly give the medication by injection or by mouth. Ketamine is not FDA approved for NPS in dementia. This is considered an off-label use of this medication, therefore it’s not covered by insurance or medicare. Which also means the use of this medication is at the provider’s discretion. 

ElderHealth has a specific protocol to establish the best ketamine care plan for our patients.

We often will utilize the adjunctive therapies of music therapy and psychotherapy to enhance the ketamine experience and efficacy. Each patient is different and those unique needs are considered when determining frequency, dosing and administration route of the medication. The great thing about ketamine is that it yields itself to be given in a variety of ways which makes it easier to individualize a plan.

We have found that patients that have a repetitive thought process and/or action,  a trauma history and/or a co morbid symptom of pain are the best candidates for ketamine and usually respond with positive results. In our experience, the personalized music playlist curated by our music therapist and therapeutic guidance by a licensed clinical social worker in combination with the ketamine enhances the effects and length of time between treatments and is often the cornerstone for positive outcomes. 

Ketamine may not cure NPS, but in the words of ElderHealth’s licensed social worker who conducts assisted psychotherapy sessions

“It can offer a mental and physical break from the relentless struggles of pain, anxiety and agitation.” 

Laura Aylmer, LCSW

Melissa Koon, ARNP

Melissa Koon, NP, is a family nurse practitioner and excels at communicating with patients no matter who they are: young or old, urban or rural, Melissa can connect. She has experience with both traditional and alternative palliative therapies, and believes that collaborating with other experts—from social workers to music therapists—is key. Melissa is the mother of four children with whom she enjoys a range of hobbies, from woodworking to playing Nintendo.

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