Management of behavioural and psychological symptoms of dementia

Abstract

Recently, there have been many publications expressing concern towards the inappropriate and excessive use of neuroleptic medication in dementia. In 2004, a safety message was issued by the Committee on Safety of Medicines of the United Kingdom concerning the use of atypical antipsychotics in patients with behavioural and psychiatric symptoms of dementia. This alert followed the analysis of manufacturer data which showed an increased risk of cerebrovascular adverse events with risperidone and olanzapine. The magnitude of increased risk in the studies analysed was in the region of three times. It has been recommended that these drugs are prescribed only following a careful assessment of benefits and risks, are used in the lowest possible dose and for a specified period of time. Although the other 'typical' neuroleptic drugs are commonly prescribed to treat behavioural and psychiatric symptoms in dementia, there is little evidence-base to support this practice. Typical antipsychotic drugs are known only to be modestly effective and can have potentially serious side-effects especially in older adults. There have been many studies on the overuse of antipsychotic medication, especially in people with dementia and those living in nursing homes. These drugs are associated with extrapyramidal side effects, increased risk of falling, excessive sedation and accelerated cognitive decline. Several trials have also shown that these drugs can be safely discontinued in many of these situations.