Long-term efficacy of olanzapine in the control of psychotic and behavioral symptoms in nursing home patients with Alzheimer's dementia

Street, J.; Clark, William S.; Kadam, D.; Mitan, S.; Juliar, Beth E.; Feldman, Peter D.; Breier, Alan

doi:10.1002/1099-1166(200112)16:1+<::aid-gps569>3.0.co;2-j

Cited by 70 publications

(26 citation statements)

References 53 publications

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“…■ Key words BPSD · cognition · AD · dimension · syndrome specific cerebral areas might be responsible for behavioural and/or cognitive manifestations [10,30] and that the acetyl-cholinesterase inhibitor drugs [28,35] or other pharmacological agents [11,40] may alleviate, more or less selectively, these symptoms. However, it is also evident that a correct evaluation of the behaviour requires the grouping of symptoms in fewer syndromes.…”

Section: Introductionmentioning

confidence: 99%

Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer?s disease

et al. 2004

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Clinical expressions of cognition and behaviour in Alzheimer's disease (AD) patients are heterogeneous. Therefore, assessing the entire range of selective cognitive and behavioural characteristics of dementia in minute detail is extremely important. However, considering that groups of different symptoms may respond to the same pharmacological agent, it is also evident that a correct evaluation of the behaviour requires the grouping of symptoms in fewer syndromes. Thus, the authors have analysed various connections between selective cognitive domains and behavioural symptoms (BPSD) in probable AD outpatients. Two hundred and forty four patients with diagnosis of probable AD, according to DSM-IV and NINCDS-ADRDA criteria were enrolled. The evaluation included the Mini Mental State Examination, the Mental Deterioration Battery, and the Neuropsychiatric Inventory. Treatment with low doses of neuroleptic drugs only was allowed. Principal component analysis condensed the 18 cognitive/behavioural variables in 7 factors namely general-cognitive, constructional abilities, hyperactivity, psychosis, anxiety, mood-excitement and mood-depression/apathy. None of the cognitive domains were included in the behavioural factors and vice-versa. Furthermore, the only BPSD which impaired continuously with progression of disease severity was apathy which was also the most severe symptom. In conclusion, many cognitive and behavioural syndromes exist in patients with AD. However, the results of this study suggest that cognition and behaviour are independent dimensions.

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Section: Introductionmentioning

confidence: 99%

Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer?s disease

et al. 2004

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“…8 This deterioration may, however, be explained by sedation 9 or the lower baseline cognition in the quetiapine group. 10 Studies of the atypical olanzapine have reported mixed results, ranging from no effect 11 to enhancing 12 or worsening cognition. 13 RCTs using risperidone for neuropsychiatric symptoms in dementia have, however, consistently found it to be effective without cognitive side effects.…”

mentioning

confidence: 99%

Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study

Livingston

Walker

Cooper

2007

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: To investigate in a longitudinal cohort of people with Alzheimer's disease whether taking antipsychotics is associated with more rapid cognitive deterioration. Method: From a sample of 224 people with Alzheimer's disease recruited as epidemiologically representative, those taking antipsychotic drugs for more than 6 months were compared with those who were not, in terms of change in three measures of cognition. The effects of potential mediators and confounders (demographic factors, neuropsychiatric symptoms, cognitive severity and cholinesterase inhibitors) were also examined. Results: No significant difference was observed in cognitive decline between those taking antipsychotics (atypical or any) and others on any measure of cognition. The only predictor of more cognitive decline was greater baseline cognitive severity (B = 3.3, 95% confidence interval 0.6 to 6

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“…[34][35][36] Some researchers explained the lower than general population incidence rate of DM during antipsychotics, in patients with dementia, to the fact that those with dementia tended toward weight loss than weight gain. 19,20 However, we found that the association between the use of antipsychotics and development of DM maintained after adjusting BMI. It means that we should focus on direct effect of antipsychotics on DM, not mediating effect of antipsychotics on weight change related to DM.…”

Section: Discussionmentioning

confidence: 60%

P2‐111: Effect of psychotropic drugs on development of diabetes mellitus in patients with Alzheimer's disease

Chang

Son

Kim

et al. 2015

Alzheimer's & Dementia

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We aimed to examine risk of diabetes mellitus (DM) among older adults with Alzheimer's disease receiving 3 types of psychotropic drugs, that is, antipsychotics, antidepressants, and sedative anxiolytics.We retrospectively analyzed data from a hospital-based Clinical Research Center for Dementia of South Korea (CREDOS) study conducted between January 1, 2008 and December 31, 2012. Participants (n ¼ 3042) with Alzheimer's disease were aged 65 or older and had no preexisting history of DM. Development of DM was identified using claims for initiating at least 1 prescription of antidiabetic medications or a diagnosis of DM during the follow-up period. Cox proportional hazards regression was used to demonstrate the Hazard ratio of DM in use of each psychotropic drug.Among the 3042 participants, 426 patients (14.0%) developed DM, representing an incidence rate of 5.2/100 person-years during an average 2.9 years of follow-up period. Among the 3 types of psychotropic drugs, antipsychotic users had a significantly higher risk of DM (hazard ratio ¼ 1.74, 95% confidence interval ¼ 1.10, 2.76) than nonusers, after adjusting covariates. Antidepressants and sedative anxiolytics did not achieve statistical significance.These results suggested that the diabetes risk was elevated in Alzheimer patients on antipsychotic treatment. Therefore, patients with Alzheimer's disease receiving antipsychotic treatment should be carefully monitored for the development of DM.

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Long-term efficacy of olanzapine in the control of psychotic and behavioral symptoms in nursing home patients with Alzheimer's dementia

Cited by 70 publications

References 53 publications

Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer?s disease

Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer?s disease

Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study

P2‐111: Effect of psychotropic drugs on development of diabetes mellitus in patients with Alzheimer's disease

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