Atypical antipsychotics for aggression and psychosis in Alzheimer's disease

Ballard, Clive; Waite, Jonathan

doi:10.1002/14651858.cd003476.pub2

Cited by 398 publications

(371 citation statements)

References 69 publications

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“…Similarly, in recent trials, no significant therapeutic effects were found for haloperidol compared with placebo and trazodone (Teri et al, 2000), compared with placebo and quetiapine (Tariot et al, 2006), and compared with risperidone and placebo (De Deyn et al, 1999). Some, although not all, RCTs with risperidone, olanzapine, and aripiprazole have shown modest efficacy for reducing aggression and overall agitation in AD (Ballard and Waite, 2006;Sink et al, 2005).…”

Section: Agitationmentioning

confidence: 94%

“…Overall, atypical antipsychotic drugs appear to have modest efficacy for treating the psychosis of AD (Ballard and Waite, 2006;Sink et al, 2005), although studies have not always found significant advantage over placebo in terms of psychotic symptoms (Kindermann et al, 2002;Schneider et al, 2006a). Schneider et al (2006a) reviewed 15 randomized controlled trials (RCTs) of atypical antipsychotics for agitation and/or psychosis of dementia that predated the CATIE-AD trial (three with aripiprazole, four with olanzapine, four with risperidone, one comparing olanzapine and risperidone, and three with quetiapine).…”

Section: Psychosismentioning

confidence: 99%

See 1 more Smart Citation

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

329

273

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In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6-1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a 'black box' warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/ or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.

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Section: Agitationmentioning

confidence: 94%

Section: Psychosismentioning

confidence: 99%

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

329

273

View full text Add to dashboard Cite

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“…Agitated Behavior Scale (ABS) [18], was used for categorization of BPSD as per ABS scores and patients were classified as mild (22)(23)(24)(25)(26)(27)(28), moderate (29)(30)(31)(32)(33)(34)(35)) and severe (>36). Agitated behavior scale (ABS) score > 22 meant absence of clinically significant agitation.…”

Section: Diagnostic and Rating Scalesmentioning

confidence: 99%

“…Amisulpride has not been investigated in refractory behavioral and psychological symptoms of dementia. Till date, no randomized double blind placebo controlled trials exist for amisulpride in BPSD [29,30].…”

Section: Durationmentioning

confidence: 99%

Amisulpride in Refractory Behavioral and Psychological Symptoms of Dementia

Dhikav¹,

Prajapati²,

Muzaffar³

et al. 2017

Ann Alzheimers Dement Care

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olanzapine, quetiapine and risperidone. There are many patients who fail to respond to these drugs [9], leaving a window for the new entry [1]. Since a sizable number of patients do not adequately respond to the available drugs [1,[9][10][11][12], drugs such as ramelteon [9] and carbamazepine [11] Amisulpride is a second generation atypical antipsychotic that selectively binds to dopamine D 2 /D 3 receptors with 5-HT 7 antagonistic effect in the limbic system of the brain [14,15]. Amisulpride has not IntroductionDementia is a common disease of the elderly and is characterized by cognitive and non-cognitive complaints [1]. Dementias involves loss of cognitive abilities and at least one of the following e.g., aphasia, apraxia, agnosia, disturbances in executive functioning [2]. The behavioural impairment in dementia interferes with a person's Activity of Daily Living [3]. It is a common cause of caregiver stress and burden and leads to poor Quality of Life [4]. Psychosis is the most common disturbance in patients with dementias with behavioral and psychological symptoms of dementia (BPSD) [5], which affects up to 90% of all dementia subjects [6]. Psychotic BPSD include verbal and physical aggression, agitation, hallucinations delusions, irritability, sleep disturbances, oppositional behaviors, and wandering type behaviors [7] etc. Course of dementias is complicated by the occurrence of BPSD [1] and is the single most predictor of hospitalization and caregiver stress [5].Currently, the antipsychotics are the most commonly offlabel drugs used in the management of BPSD [8]. These have been the mainstay of the treatment of BPSD, especially the psychotic behaviours. The commonly used drugs for this purpose include AbstractBackground: Amisulpiride is an atypical antipsychotic used extensively in Schizophrenia and related disorders. The current study explored the safety and tolerability of amisulpride in refractory patients with behavioral and psychological symptoms of dementia (BPSD), especially in agitation and/ or aggression.

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“…We rejected antipsychotics as treatment for apathy in AD given the lack of evidence from controlled trials suggesting treatment effect (37–40) and concerns about increased mortality risk resulting in an FDA “black box” warning (41–43). …”

Section: Issues In Designing a Trial To Test Treatments For Apathymentioning

confidence: 99%

Designing a Trial to Evaluate Potential Treatments for Apathy in Dementia: The Apathy in Dementia Methylphenidate Trial (ADMET)

Drye

Scherer

Lanctôt

et al. 2013

The American Journal of Geriatric Psychiatry

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Background Research on efficacious treatments for apathy in Alzheimer’s disease has been hindered by a lack of consensus diagnosis, difficulties in measurement, and studies with small sample sizes. Methods In designing the Apathy in Dementia Methylphenidate Trial (ADMET), a trial to evaluate the efficacy and safety of methylphenidate for the treatment of apathy in Alzheimer’s disease, we encountered the following issues: defining and measuring apathy, distinguishing apathy and depression, determining an appropriate test treatment, selecting relevant secondary outcomes, recruiting participants, and deciding on a suitable method for treatment unmasking. ADMET is a 6-week randomized, double-masked, placebo-controlled multicenter clinical trial with two parallel treatment groups assigned in a 1:1 ratio with randomization stratified by clinical center. The recruitment goal is 60 randomized participants over 2 years. The primary outcomes are change in apathy severity as measured by the Apathy Evaluation Scale and the Alzheimer Disease Cooperative Study-Clinical Global Impression of Change. Conclusion The design decisions made for ADMET are important elements to be considered in trials assessing the safety and efficacy of medications for clinically significant apathy in Alzheimer’s disease.

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Atypical antipsychotics for aggression and psychosis in Alzheimer's disease

Cited by 398 publications

References 69 publications

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Amisulpride in Refractory Behavioral and Psychological Symptoms of Dementia

Designing a Trial to Evaluate Potential Treatments for Apathy in Dementia: The Apathy in Dementia Methylphenidate Trial (ADMET)

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