Treatment of agitation in AD

Teri, Linda; Logsdon, Rebecca G.; Peskind, Elaine R.; Raskind, Murray A.; Weiner, Myron; Tractenberg, Rochelle E.; Foster, Norman L.; Schneider, Lon S.; Sano, Mary; Whitehouse, Peter J.; Tariot, Pierre N.; Mellow, Alan M.; Auchus, Alexander P.; Grundman, Michael; Thomas, Ronald G.; Schafer, Kimberly; Thal, Leon J.

doi:10.1212/wnl.55.9.1271

Cited by 306 publications

(194 citation statements)

References 33 publications

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“…All three "weak" studies lost points because of high attrition rates (Cohen-Mansfield and Werner, 1997;Toseland et al, 1997;Teri et al, 2000). Details are presented below.…”

Section: Resultsmentioning

confidence: 99%

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Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

O'Connor

Ames

Gardner

et al. 2008

IPG

176

147

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Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).Method: English language reports published or in press by December 2006 were identified by means of database searches, checks of previous reviews and contact with recognized experts. Papers were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another.Results: Only 25 of 118 relevant studies met every specification. Treatment proved more effective than an attention control condition in reducing behavioral symptoms in only 11 of the 25 studies. Effect sizes were mostly small or moderate. Treatments with moderate or large effect sizes included aromatherapy, abilityfocused carer education, bed baths, preferred music and muscle relaxation training.Conclusions: Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were mostly small to moderate with a short duration of action. This limited action means that treatments will work best in specific, timelimited situations. In the few studies that addressed within-group differences, there were marked variations in response. Some participants benefited greatly from a treatment, while others did not. Interventions proved more effective when tailored to individuals' preferences.

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“…All three "weak" studies lost points because of high attrition rates (Cohen-Mansfield and Werner, 1997;Toseland et al, 1997;Teri et al, 2000). Details are presented below.…”

Section: Resultsmentioning

confidence: 99%

“…While there were trends in this direction (Wells et al, 2000;Gormley et al, 2001;Sloane et al, 2004), the outcomes were not striking. In the largest study, Teri et al (2000) compared two medications, an antipsychotic and an antidepressant, with a family behavior management training program. None worked better than a placebo tablet.…”

Section: Treatmentsmentioning

confidence: 99%

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

O'Connor

Ames

Gardner

et al. 2008

IPG

176

147

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“…In another meta-analysis, Lonergan et al (2001) found that haloperidol was beneficial for dementia patients with aggression, but not for general agitation (ie wandering, verbal agitation, etc). 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%

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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“…46,47 However, another study suggested that its efficacy was similar to placebo. 48 Pharmacological treatment of sexually disinhibited behaviours There are no drugs currently licensed in the UK for sexually disinhibited behaviours; neuroleptics, anti-androgens, oestrogens, LHRH analogues, serotonergics and gabapentin are occasionally used off-licence. 5 There is scarce evidence for neuroleptics.…”

Section: Anticonvulsantsmentioning

confidence: 99%

Pharmacological alternatives to antipsychotics to manage BPSD

Mishriky¹,

Reyad²

2018

Prog Neurol Psychiatry

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Non‐pharmacological management remains the initial approach for behavioural and psychological symptoms of dementia (BPSD). However, pharmacological management has a role in specific situations. Here, the authors examine the pharmacological management of elderly patients with dementia and challenging behaviour and aim to raise awareness of the risk of complications associated with first‐ and second‐generation antipsychotic medications.

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Treatment of agitation in AD

Abstract: Comparable modest reductions in agitation occurred in patients receiving haloperidol, trazodone, BMT, and placebo. More effective pharmacologic, nonpharmacologic, and combination treatments are needed.

Cited by 306 publications

References 33 publications

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

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

Pharmacological alternatives to antipsychotics to manage BPSD

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