NEUROLEPTIC TREATMENT OF BEHAVIORAL AND PSYCHIATRIC SYMPTOMS IN DEMENTIA

Abstract

Although the use of neuroleptics is common in the treatment of behavioral and psychiatric symptoms in dementia, there are relatively few placebo-controlled studies to guide clinical practice. There is some evidence that indicates that the symptoms of hostility, aggression and psychosis (hallucinations and delusions), particularly when these symptoms are severe, respond best to conventional neuroleptics, but side effects (extrapyramidal, cardiovascular, anticholinergic and cognitive) are frequent. There is little consensus on what constitutes appropriate duration of treatment for many of these symptoms, and there have been some suggestions that treatment with conventional neuroleptics actually accelerates disease progression. Novel neuroleptics are now being used more widely in dementia patients and appear to be better tolerated than their conventional counterparts with at least similar efficacy. Further studies will be necessary to clarify neuroleptic-responsive symptoms, appropriate duration of treatment and the effect of conventional and novel neuroleptic treatment on the natural history of dementia. Learning objectives: •To understand the indications and choice of neuroleptics in the treatment of behavioral and psychiatric symptoms in dementia. •To understand the side-effect and toxicity profile of neuroleptics in dementia patients. •To understand where the gaps are in our current knowledge regarding the use of neuroleptics in dementia patients.