Abstract
Dementia affects about 47 million people worldwide, number expected to exponentially increase within 30 years. Alzheimer’s disease (AD) is the most common dementia type, accounting on its own for almost 70% of all dementia cases. Behavioral and psychological symptoms (BPSD) frequently occur during the disease progression; to treat agitation, aggressiveness, delusions and hallucinations, the use of antipsychotic drugs should be limited, due to their safety issues. In this literature review regarding the use of antipsychotics for treating BPSD in dementia, the advantages and limitation of antipsychotic drugs have been evaluated. The available medications for the management of behavioral and psychological symptoms are the antipsychotics, classed into typical and atypical, depending on their action on dopamine and serotonin receptors. First generation, or typical, antipsychotics exhibit lack of tolerability and display a broad range of side effects such as sedation, anticholinergic effects and extrapyramidal symptoms. Atypical, or second generation, antipsychotics bind more selectively to dopamine receptors and simultaneously block serotonin receptors, resulting in higher tolerability. High attention should be paid to the management of therapy interruption or switch between antipsychotics, to limit the possible rebound effect. Several switching strategies may be adopted, and clinicians should “tailor” therapies, accounting for patients’ symptoms, comorbidities, polytherapies and frailty.
Highlights
The term “dementia” refers to a clinical syndrome characterized by progressive cognitive decline that interferes with independence in everyday activities
Despite the warnings issued by the US Food and Drug Administration (FDA), the European Medicines Agency and the UK Medicines and Healthcare Products Regulatory Agency, antipsychotics are often used in individuals with dementia for sustained periods (≥6 months) [18,19], they are associated with increased risk of death, cerebrovascular adverse events (CVAEs), Parkinsonism, sedation, gait disturbance, cognitive decline and pneumonia [20]
A more recent systematic review of 36 Randomized Clinical Trials (RCTs) compared the efficacy of risperidone, haloperidol, SSRI as a class and dextromethorphan/quinidine in treating agitation in people affected by all-types dementias; the results showed that haloperidol was almost the least efficacious among all comparators, dissuading prescription of this medication in this particular case [33]
Summary
The term “dementia” refers to a clinical syndrome characterized by progressive cognitive decline that interferes with independence in everyday activities. Neuropsychiatric symptoms are associated with several negative outcomes, such as faster cognitive decline, functional impairment, reduced independence and inability to complete activities of daily living, with progression to more severe stages of dementia and increasing risk for secondary complications such as falls and fractures, causing higher hospitalization rates and eventually early institutionalization [8]. During the last few decades, several studies have been conducted with the aim of identifying possible AD sub-syndromes defined by combinations of different neuropsychiatric symptoms Most of these studies included only patients with. The study showed no statistically significant impact of different neuropsychiatric sub-syndromes on the rate of cognitive decline, indicating that the cognitive progression of dementia seems to be scarcely affected by the presence of specific clusters of symptoms [13]. Dopamine (DA) is fundamental for motor control, due to the activity within the basal ganglia, but is responsible for the processing of cognitive information, perception and adaptation to the environment [16]
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