Objective: There is increasing focus on the treatment of Behavioral and Psychological Symptoms of Dementia(BPSD). The NeuroPsychiatric Inventory (NPI) is a widely used instrument for the assessment of BPSD-symptoms. The aim of the study is to examine the response on neuroleptic treatment of 1) individual NPI-items and of 2) the clustered NPI-items hyperactivity, mood/apathy and psychosis.
Design: Subanalysis of unblinded data of a two-arm treatment study (haloperidol vs. olanzapine) of patients with BPSD. Changes of NPI-scores before and after treatment were analysed with regard to both individual symptoms and clusters of symptoms.
Materials and Methods: Forty-two patients with different types of dementia were treated with evidence based doses (i.e. haloperidol 1-3mg or olanzapine 2.5-7.5mg) for BPSD. The mean age was 82, the mean MMSE-score was 10.5. The NPI was administered at t=0 and t=35 days.
Results: The NPI-item 'agitation' showed a significant improvement (p=0.000). There was also improvement on the items 'eating disorder' (p=0.005) , 'irritability' (p=0.008) and 'delusions' (p=0.02). The item 'hallucinations' did not show any improvement, whereas the remaining items showed slight non-significant improvements. On the cluster level the 'hyperactivity-cluster' showed significant improvement (p=0.001), as well as the 'mood/apathy-cluster' (p=0.005), whereas the 'psychosis-cluster' did not show any significant improvement.
Conclusion: In general, the results of the study were in line with our expectations. The lack of a significant improvement of the 'psychosis-cluster' surprised us. In contrast, the effect on the 'hyperactivity' and 'mood/apathy' clusters was anticipated. These findings suggest that low-dosis neuroleptic treatment of BPSD is a 'major tranquilization' rather than an antipsychotic treatment. This challenges the commonly held view that specific symptoms (i.e. specific NPI-items) require a specific treatment. A broader approach of target symptoms is warranted and more studies comparing neuroleptics with SSRI's, moodstabilizers and Alzheimer-medication in het treatment of BPSD are recommended. The presence of a placebo-group would have made it easier to draw conclusions on the efficacy of the study-drugs
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