Non‐neuroleptic medications in the management of agitation in Alzheimer's disease and other dementia: A selective review

Abstract

AbstractBoth neuroleptic and non‐neuroleptic medications are widely used to treat symptomatic behaviors in dementia patients. There is a substantial body of literature suggestig that neuroleptics are modestly effective in treating these symptoms, but the magnitude of their effect is limited. Non‐neuroleptic medications such as anticonvulsants and antidepressants have been advocated as useful in treating certain symptoms but have not been as well studied. This article critically reviews the published evidence for the effectiveness of selected non‐neuroleptic medications in treating behavioral symptoms in elderly dementia patiens, especially those with possible Alzheimer' disease. The medications reviewed include lithium, β‐adrenergic blockers, trazodone, carbamazepine, buspirone, I‐deprenyl, and serotonin uptake blockers, reflecting the point of view that pharmacological approaches to the problem of agitation in dementia have included a variety of psychotropic medications. Most of these medications were not tried specifically with Alzheimer' disease patients, however, but in patients with various organic mental syndromes. The literature consists almost entirely of clnical series and case reports, making interpretations of the efficacy of individual medications difficult. With the singular exception of the serotonin uptake blocker citalopram, the few placebo‐controlled studies are of small sample sizes, showing at best very modest efficacy for the study medication. Despite their widespread use, there is very little published empirical evidence for the effectiveness of these novel treatments for treating behavioral symptoms in elderly dementia patients.