Pharmacotherapy of Behavioral and Psychological Symptoms of Dementia: Time for a Different Paradigm?

Abstract

Behavioral and psychological symptoms of dementia can occur in 60-80% of patients with Alzheimer's disease or other dementing illnesses, and are important in that they are a source of significant caregiver stress and often precipitate nursing home placement. These symptoms, namely, aggression, delusions, hallucinations, apathy, anxiety, and depression, are clinically managed with a variety of psychotropic drugs such as antipsychotics, antidepressants, antiepileptic drugs, and benzodiazepines. Various advances in the neuropathophysiology and pharmacotherapy must be considered in the optimal design of regimens for patients with these symptoms.

Efficacy and Tolerability of Risperidone, Yokukansan, and Fluvoxamine for the Treatment of Behavioral and Psychological Symptoms of Dementia

“…4 Currently, the most common drug therapy for BPSD is the use of antipsychotics, antidepressants, antiepileptics, or benzodiazepines. 5 Conventional antipsychotics have demonstrated modest but consistent effectiveness against BPSD. 6 However, elderly patients with dementia are particularly sensitive to adverse events (AEs), such as extrapyramidal symptoms (EPSs) and cognitive decline.…”

Comparison of Topiramate and Risperidone for the Treatment of Behavioral Disturbances of Patients With Alzheimer Disease

“…3 Recently, the most frequently prescribed pharmacotherapy for psychosis and behavioral disturbances associated with dementia are antipsychotics. 4 The typical antipsychotics have demonstrated a modest but significant beneficial effect 5,6 ; however; the elderly patients are particularly sensitive to adverse events including movement disorders such as extrapyramidal symptoms. 7 On the other hand, the Batypical antipsychotic[ medications, although at times are important in helping patients to control their behaviors, have been associated with weight gain, diabetes, and hypercholesterolemia.…”

Correlates of Behavioral Disturbances and Pattern of Psychotropic Medication Use in Five Skilled Nursing Facilities

“…9 Even for instances in which there is consensus, treatment often varies with local community practices 10 and clinician biases. 11 Research on agitated behaviors in dementia is characterized by inconsistent and imprecise definition of BD, 12 unavailability of reliable and uniform clinically applicable measurement tools, 12 and absence of consensus guidelines for treatment. 13 The 7th International Psychogeriatric Association Congress (1995) issued a number of recommendations for research priorities.…”

“…18,23 Although other agents, such as selective serotonin reuptake inhibitors (SSRIs), 24-26 valproic acid, 27,28 and benzodiazepines, 19,20,29,30 are also being used for BDs, it is not clear how clinicians select a specific agent for a particular BD. 10,11 It has been previously shown that psychiatric symptoms and BD may co-occur in dementia. [31][32][33] However, treatment of these psychiatric symptoms may have either no effect on BD 10 or a beneficial effect that is independent of the medication's effect on psychosis.…”

“…10 These findings support the distinction between psychoses and BDs and can be used to improve the prescribing patterns of psychotropic medications, 10 specifically a more targeted approach to the use of neuroleptic agents. 11 The objective of our study was to examine the pattern of psychotropic medication use in five skilled nursing facilities (SNFs) in relation to the five most frequently encountered clusters of BD during a 2-week sampling period. Our goal was to determine whether pharmacologic interventions were consistent with current recommendations and to identify potential areas for improvement.…”