Behavioral and psychiatric symptoms such as agitation and psychosis occur frequently in people with dementia, often leading to distress in the people who experience them and additional burden for their caregivers.[1] However, these symptoms can resolve spontaneously over a period of a few months, as evidenced by naturalistic studies and high placebo response rates in clinical treatment trials.
If pharmacological treatments are to be utilized as part of the clinical management of dementia, selecting an agent with a good tolerability profile is essential. This is particularly important with respect to antipsychotics, as conventional antipsychotics have a detrimental side effect profile including parkinsonism and an increased risk of falls.[2,3] In addition, antipsychotic drugs with prominent anticholinergic properties may have an acute negative impact upon cognition, while some evidence indicates a broader impact of antipsychotics on the rate of progression of cognitive decline and neuronal loss.[4] Recent studies also indicate that a range of antipsychotics have a detrimental impact upon quality of life in these individuals.[5] A preliminary crossover study indicates, however, that changing conventional antipsychotics to one of the newer atypical agents, eg quetiapine, may be associated with improvements in quality of life amongst people who require ongoing maintenance treatment (Ballard, unpublished data). Although much of the evidence is preliminary, there is emerging evidence of a number of potential advantages for newer atypical antipsychotics such as quetiapine in this regard.
References
1. Parnetti L, Amici S, Lanari A, Gallai V. Pharmacological treatment of non-cognitive disturbances in dementia disorders. Mech Ageing Dev 2001; 122: 2063-2069.
2. Arana GW. An overview of side effects caused by typical antipsychotics. J Clin Psychiatry 2000; 61 (Suppl 8): 5-11.
3. Casey DE. Barriers to progress – the impact of tolerability problems. Int Clin Psychopharmacol 2001; 16 (Suppl 1); S15-S19.
4. Byerly MJ, Weber MT, Brooks DL, Snow LR, Worley MA, Lescouflair E. Antipsychotic medications and the elderly. Effects on cognition and implications for use. Drugs and Aging 2001; 18; 45-61.
5. Ballard C, O’Brien J, James I, Mynt P, Lana M, Potkins D et al. Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills and psychotropic drugs. Int Psychogeriatr 2001; 13: 93-106.
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