Psychopharmacotherapy of behavioral disorders in patients with dementia

Abstract

Behavioral disorders in dementia are common and are the most important symptoms with regard to socio-economic burden. Up to now there is no common international agreement of how to define and measure these disorders. Antidementia trials focus mainly on cognition. Investigations of neurobiological corrolaries of disturbed behavior in the dementias are rare. The same holds true for studies on the longitudinal course of behavioral disorders and their interrelation. Many symptoms may be the expression of variable conditions, e.g., agitation may be related to anxiety or akathisia. In primary care, hospitals and nursing homes, antipsychotics are most often chosen for their treatment. The available data demonstrate at least a modest efficacy. New neuroleptics (risperidone, clozapine, olanzapine) offer some advantages with regard to the risk benefit ratio. Benzodiazepines are frequently prescribed, but seem to be superior to neuroleptics only for the treatment of sleep disorders. Antidepressants, carbamazepine or valproic acid offer some benefits, but do not provide immediate effects, which may the reason why they are used much less. For long-term treatment of many behavioral symptoms, they may however be superior. Drugs should also be chosen with regard to dementia etiology. For example, physicians should consider the high neuroleptic sensitivity in dementia of Lewy body type and the anticholinergic sensitivity in dementia of Alzheimer type. Empirical evidence indicates overtreatment of the demented population with sedating psychotropic drugs. With regard to the instability of behavioral disorders in the time course the necessity of drug treatment should always be (re)evaluated.