Risperidone in the treatment of behavioural and psychological symptoms of dementia in patients diagnosed with vascular or mixed-type dementia

Abstract

Objective Studies have found that the atypical antipsychotic drug, risperidone, reduces non-cognitive symptoms, such as aggression, agitation, and psychosis, in patients with Alzheimer's disease. This study assessed whether these effects extend to patients with vascular or mixed-type dementia. Methods In this multicentre, open-label, prospective study, 75 elderly patients with vascular or mixed-type dementia and concomitant behavioural and psychological symptoms were treated with risperidone for up to 6 months. Results Risperidone decreased the frequency and severity of overall behavioural and psychological symptoms, as determined by the Neuropsychiatric Inventory, to a mean total score of 7.2±0.7 at end-point compared with 21.0±1.5 at baseline (P<0.001). Risperidone improved functional capacity (Blessed Dementia Rating Scale, Reisberg's Global Deterioration Scale) and depression (Cornell Scale for Depression in Dementia). A total of four adverse events (5.3%) were spontaneously reported: two cases of hypotension, one of somnolence, and one of paresthesia. Scores on the Udvalg for Kliniske Undersogeler extrapyramidal symptom subscale remained stable from baseline to end-point. Conclusion Overall, these findings indicate that risperidone was effective in reducing behavioural and psychological symptoms and was well tolerated, particularly with respect to extrapyramidal symptoms, in this elderly population diagnosed with vascular or mixed-type dementia.

Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame?

“…Alfonso et al [57] showed that risperidone was an effective treatment for both VaD and MixD sub-types and it is, up to date, the sole direct comparison between specific antipsychotic prescribing patterns in different dementia sub-types. The use of risperidone at a mean dose of 1.6 mg/day for 6 months was of clinical benefit in the treatment of aggression, psychomotor agitation and psychosis.…”

Ethical dilemma associated with the off‐label use of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia

“…Cruz-Jentoft et al 11 conducted a multicenter, open-label, prospective study treating 75 patients with vascular or mixed-type dementia and concomitant behavioral and psychological symptoms with risperidone for up to 6 months. Risperidone decreased the frequency and severity of overall behavioral and psychological symptoms.…”

Risperidone for the Treatment of Dementia-Related Psychosis: A Systematic Review and Meta-Analysis

“…Cruz-Jentoft et al, reported two cases of hypotension, one somnolence, and one paresthesia[39]. In the Mintzer et al, study, patients who were given risperidone experienced a higher incidence of treatment-related side effects compared to those given a placebo, with somnolence being reported signi cantly more often in the risperidone group (16.2% versus 4.6%)[42].…”

“…Seven studies found no signi cant changes in the scores of the adverse event paired with the beginning of the study in the risperidone group[17-19, 31, 36-38]. In the Cruz-Jentoft et al, study, the Undersøgelser Side Effects Rating Scale for Clinicians (UKU-SERS-Clin) extrapyramidal subscale ratings indicating a temporary reduction in extrapyramidal symptoms during the course of the study, with signi cantly lower score at month 3[39]. On the other hand, De Deyn et al found that the frequency of combined EPS-related adverse effects was higher in the complete risperidone group, with a rate of 16.3%, compared to the placebo group's rate of 11.6%, and this seemed to vary with the dose[40].…”