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Pharmacological Treatment of the Psychosis of Alzheimer’s Disease

What Is the Best Approach?

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Abstract

Psychosis of Alzheimer’s disease (PAD) forms part of the behavioural and psychological symptoms of dementia (BPSD). PAD includes symptoms of psychosis such as hallucinations or delusions, and may be associated with agitation, negative symptoms or depression. Even though the US FDA has not approved any medication for the treatment of PAD, atypical antipsychotics have been widely used and favoured by geriatric experts in the management of the condition in view of their modest efficacy and relative safety. However, the recent FDA warnings regarding the cardiac, metabolic, cerebrovascular and mortality risks associated with the use of these drugs in elderly patients with dementia have caused serious concerns regarding their use. Nevertheless, until an effective and safe medication is approved by the regulatory agencies for PAD, clinicians do not have a better choice than atypical antipsychotics for the management of the serious symptoms of this condition.

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Acknowledgements

Dr Madhusoodanan has acted as a consultant for and has received honoraria from Bristol-Myers Squibb and AstraZeneca; owns stock in Pfizer and Merck; and has received grants from Janssen, Eli Lilly, AstraZeneca, Bayer and Pfizer. Dr Brenner has acted as a consultant for Bristol-Myers Squibb, Janssen, AstraZeneca, Eli Lilly and Pfizer; has received honoraria from AstraZeneca, Janssen and Eli Lilly; and has received grants from AstraZeneca, Bristol-Myers Squibb and Janssen. Dr Gupta has acted as a consultant for Eli Lilly and Forest; and has received honoraria from Eli Lily, Forest, GlaxoSmithKline and AstraZeneca. Dr Shah has no conflicts of interest that are directly relevant to contents of this review.

No sources of funding were used to assist in the preparation of this review.

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Authors and Affiliations

  1. St John’s Episcopal Hospital, 327 Beach 19th Street, Far Rockaway, New York, 11691, USA

    Subramoniam Madhusoodanan & Ronald Brenner

  2. SUNY Health Science Center, Brooklyn, New York, USA

    Subramoniam Madhusoodanan, Payal Shah & Ronald Brenner

  3. Olean General Hospital, Olean, New York, USA

    Sanjay Gupta

  4. SUNY, Buffalo, New York, USA

    Sanjay Gupta

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  1. Subramoniam Madhusoodanan
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Correspondence to Subramoniam Madhusoodanan.

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Madhusoodanan, S., Shah, P., Brenner, R. et al. Pharmacological Treatment of the Psychosis of Alzheimer’s Disease. CNS Drugs 21, 101–115 (2007). https://doi.org/10.2165/00023210-200721020-00002

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