Dear Doctor: My mother is suffering from dementia and is increasingly difficult, but I'd hate for her to be given antipsychotics. Isn't there anything else that could be done to keep her calm?

Dear Reader: My heart goes out to you and your family. Dementia is one of the most difficult diseases to deal with -- for both patients and their loved ones. The loss of memory and the inability to incorporate new information is a struggle for many elderly patients. Some are able to cope with the loss of memory, but for others, the chaos of a poorly interpreted world causes agitation, irritability and anger.

Patients often scream about problems that aren't even part of their present reality -- leaving family members and health care staff struggling to manage their seemingly irrational agitation. Nursing homes in particular often request some form of treatment, whether it be restraints or medication, to calm these patients and to protect their employees.

Doctors often prescribe benzodiazepines or antipsychotic medications for such cases, but, of course, they have side effects. Most notably, they sedate patients to such an extent that their perception of reality is further altered. Further, antipsychotic medication has been linked to an increased risk of stroke and death.

There may be a better way. Many nursing facilities are now implementing a new program called Oasis. This program assesses both the biologic and psychological needs of the patient, shifting the emphasis away from a person's disabilities and focusing on his or her personhood. Early results are promising.

A 2017 study assessed the implementation of Oasis in 93 Massachusetts nursing homes, during which program coordinators and two to three staff members were trained in how to communicate with people suffering from memory impairment. These caregivers then helped train others within the nursing facility. Implementation of the Oasis program was verified by staff completion of webinars, trainer support meetings and training modules.

In comparing those facilities to 831 nursing facilities in New York and Massachusetts that didn't implement the program, researchers found that the use of antipsychotic medications dropped by 22.3 percent in the Oasis facilities, compared to a 17.2 percent drop in non-Oasis facilities.

Note that the drop in antipsychotic use appeared to be largely related to national trends, meaning that due to the awareness of side effects, practitioners overall are prescribing fewer antipsychotic medications to nursing home patients with dementia. That said, the Oasis program did show an additional benefit, supporting the idea that better training of staff can reduce some of the behavioral disturbances seen in nursing homes.

Another option for agitated patients is the use of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. These drugs -- the best studied in this respect is citalopram -- can be comparable in efficacy to antipsychotic medications, but without the significant side effects.

Finally, exercise, music and pet therapy also play a role in decreasing the agitation seen in those with dementia. All of these are worth exploring as you seek to maximize your mother's quality of life.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My 80-year-old mother has been diagnosed with congestive heart failure. What is it, and is there anything she can do to keep it from getting worse?

Dear Reader: In congestive heart failure, the heart is no longer able to pump blood efficiently. This can be because of narrowing of the arteries that serve the heart, diabetes, high blood pressure, heart valve disease, congenital defects or damage to the heart muscle from a heart attack.

Although heart failure can't be cured, it can be managed with medication and lifestyle changes. To begin with, basic healthy-living guidelines are more important than ever. Maintain a healthy weight, get daily exercise and keep blood pressure under control.

In addition:

-- Be vigilant about medication: Your mother's cardiologist will have prescribed one or more drugs to manage the effects of her declining heart function. These may include a diuretic to deal with excess fluid, a beta-blocker to manage arrhythmias, an anticoagulant, statins to control cholesterol and medication to control heart rate.

-- Know your meds: You and your mother should learn the purpose of each drug that she takes. It's a good idea to post a detailed list of her daily drug regimen in a visible spot. Write down the name of each drug, the amount she must take and the time of each dose. Be sure to include potential side effects for each medication so if something goes wrong, that information is easily available.

-- Eat a heart-friendly diet: Get your mom to skip the processed foods. Instead, go for fresh fruit and vegetables, whole grains, beans and legumes. Protein should come from lean meats and fatty fish like salmon, which is loaded with omega-3 fatty acids. Stick to healthy fats like olive oil. Limit or quit caffeine, and steer clear of sugar and sugary drinks.

-- Be aware of salt: Sodium makes you retain fluid, so limiting salt is important for your mom. Most of the salt in our diets comes not from the shaker on the table, but from processed foods. Read labels and limit sodium to 2,000 milligrams per day.

-- Watch the fluids: We're talking about an important balancing act here. We need to take in enough fluids to stay hydrated, but for people with heart failure, too much can make it harder for the heart to pump. Your mother's cardiologist will have given her a target amount, likely in the range of 48 to 64 ounces per day. It's important that she stick to it. And don't forget that juice and soup count as liquids.

-- Get on the scale every day: A sudden weight gain of 2 pounds or more can indicate a serious problem. If that should happen, your mother should call her doctor immediately.

-- Look for other warning signs: dizziness, fainting, sudden shortness of breath, heart palpitations, increasing exhaustion, and abrupt swelling in the feet, legs or ankles. Any of these should be reported to her doctor right away. Even a change in her physical abilities -- a walk that had been easy and has now become laborious -- can indicate problems.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Could acupuncture help my carpal tunnel syndrome?

Dear Reader: Carpal tunnel syndrome (CTS) is caused by compression of the median nerve within the wrist, specifically in an area called the carpal tunnel. The symptoms include pain or numbness that radiates to the first three fingers of the hand. The sensations can awaken patients at night or strike when they're doing certain activities. When the median nerve is significantly compressed, a person can develop weakness in the thumb and fingers and have difficulty even holding a cup. Wrist splints, physical therapy, NSAIDs and steroids can initially address the condition, while surgery is often recommended for severe cases. But only recently has acupuncture been studied for carpal tunnel syndrome.

Let's start with a 2011 review of multiple studies of acupuncture for carpal tunnel syndrome. Many studies were not randomized controlled trials, but the authors were able to evaluate six trials: four done in China, one from the United States and one from Germany. Five of the studies used needle acupuncture, and one of the studies used laser acupuncture, which targets acupuncture points with low-energy laser beams.

The U.S. study compared acupuncture in traditional acupuncture points with acupuncture in random points, called sham acupuncture. That study found no difference between the two types of acupuncture. Two studies that compared steroid injections to acupuncture found a greater benefit with the use of acupuncture. A study comparing massage to acupuncture with massage found greater benefit with the acupuncture version than with the massage alone. And a fifth study, comparing acupuncture to oral steroids, found only a mild benefit from acupuncture. As for the laser acupuncture trial, it found a greater benefit with laser upon traditional acupuncture points versus laser upon sham acupuncture points.

Overall, those authors concluded that the data supporting acupuncture for carpal tunnel syndrome are encouraging, but not convincing.

A 2012 study performed in Iran was slightly more positive. It compared the use of wrist splints at night along with two acupuncture treatments per week for four weeks versus the use of night splints along with B12 vitamins and sham acupuncture. Symptom scores stayed unchanged in the sham acupuncture group, but significantly improved with the use of traditional acupuncture points. In addition, nerve function slightly improved with the use of traditional acupuncture points, but not with sham acupuncture.

A 2017 U.S. study divided 79 carpal tunnel patients into three treatment groups: one group that received acupuncture with electrical stimulation against traditional points near the wrists; another group that used sham acupuncture; and a last group that used acupuncture with electrical stimulation against traditional points, but in an area far from the wrists. Each group had 16 treatments over eight weeks.

The authors found a greater improvement of symptoms with the use of traditional wrist acupuncture and electrical stimulation versus those who had sham acupuncture. They also found improvements in nerve conduction using the acupuncture with electrical stimulation against both local and distant points. What was most interesting about this study was that the authors showed how acupuncture in traditional, and not sham, acupuncture points caused brain changes on functional MRIs, which correlated with a decrease in symptoms of CTS.

If you have mild to moderate carpal tunnel syndrome, it certainly seems worth considering acupuncture in addition to wrist splints at night and physical therapy. However, more studies are needed to solidify this recommendation.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)