Atypical antipsychotics, when used at appropriate doses, are effective in managing behavioral and psychological symptoms in patients with dementia. Published, double-blind, randomized, placebo-controlled trials show that the largest number of elderly patients were treated with risperidone (N = 1,306), followed by olanzapine (N = 444), quetiapine (N = 284), and aripiprazole (N = 208). Consistently significant improvements in symptoms were observed for the three, 12-week risperidone trials versus placebo. Atypical antipsychotics, when used at appropriate doses, are well tolerated by elderly patients. Since age is a risk factor for cerebrovascular disease, the elderly consequently have an increased risk of cerebrovascular adverse events (CAE). During the 12-week, placebo-controlled, Australian trial of risperidone in 337 elderly patients with dementia (mean age = 84 yrs), 3 placebo-treated patients (1.8%) and 15 risperidone-treated patients (9.0%) reported cerebrovascular adverse events (CAEs). This finding prompted a combined reanalysis of CAE risk data from all placebo-controlled risperidone trials in the elderly (combined mean age = 82 yrs). Overall CAE risk appeared statistically greater for patients receiving risperidone. However, when serious CAEs including stroke were analyzed, no significant differences were observed between risperidone and placebo. In addition, most of those patients reporting CAEs had medical histories significant for predisposing cerebrovascular risk factors including hypertension, atrial fibrillation and diabetes mellitus. Several specific cases will be discussed to highlight this. More studies are required to further assess CAE risk for risperidone and all atypical antipsychotics.
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