Pharmacotherapy for behavioral and psychological symptoms of dementia in the elderly

PURPOSE: The use of atypical antipsychotics for maximizing clinical efficacy and overall health in patients with neuropsychiatric symptoms of dementia is discussed. SUMMARY: Psychotic and behavioral symptoms are common among older patients with dementia, and an accurate diagnosis can be obscured by complex presentation of symptoms and comorbidities. When initiating pharmacotherapy in this patient population, it is important to consider the increased presence of comorbidities and the additive pharmacologic effects of concomitantly administered drugs. Atypical antipsychotics are among the most well-studied therapeutic classes of psychoactive medications and are frequently utilized for treating psychotic symptoms and agitation in the elderly. These medications have distinct pharmacologic profiles with different liabilities for adverse effects such as sedation, metabolic disturbances, and anticholinergic effects. Recent findings from the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) study demonstrate that although these agents have some efficacy, their adverse effects may limit their utility in patients. CONCLUSION: The adverse effect profile should be an important consideration for clinicians selecting an atypical antipsychotic for use in this population.