The journal of nutrition, health & aging

, Volume 16, Issue 6, pp 557–561 | Cite as

Are atypical antipsychotics safer than typical antipsychotics for treating behavioral and psychological symptoms of dementia?

  • A. Gurevich
  • V. Guller
  • Y. N. Berner
  • S. TalEmail author


Atypical antipsychotics seem to be preferable than conventional agents in treating psychological symptoms of dementia (BPSD), because they have substantially lower risks of extrapyramidal neurological effects with lower reported rates of parkinsonism and tardive dyskinesia. However, in the course of time, with the increase in their use, more and more side effects have been reported. The benefits and risks of antipsychotic treatment should be carefully evaluated according to the co-morbidity and the severity of the psychological and behavioral symptoms and their impact on the individual elderly patient. It is recommended to keep those medications in the lower range of therapeutic doses. Due to the complexity of the individual patient, no guidelines have been yet established. Therefore, clinical judgment should be used in applying the dose and the type of those drugs.

Key words

Elderly dementia conventional antipsychotics atypical antipsychotics BPSD 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia. JAMA 2005;19:1934–1943.CrossRefGoogle Scholar
  2. 2.
    Trifiro G, Spina E, Gambassi G. Use of antipsychotics in elderly patients with dementia: Do atypical and conventional agents have a similar safety profile? Pharmacol Res 2009;59:1–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Schneider LS, Pollock VE, Lyness SA. A metaanalysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990;38:553–563.PubMedGoogle Scholar
  4. 4.
    Jeste DV, Dolder CR, Nayak GV, Salzman C. Atypical antipsychotics in elderly patients with dementia or schizophrenia: review of recent literature. Harv Rev Psychiatry 2005;13:340–351.PubMedCrossRefGoogle Scholar
  5. 5.
    Schneider LS, Dagerman K, Insel, PS. Efficacy and adverse effects of atypical antipsychotics for dementia: Meta-analysis of randomized, placebo-controlled trials. Am J Geriatric Psychiatry 2006;14:191–210.CrossRefGoogle Scholar
  6. 6.
    Ballard C, Creese B, Corbett A, Aarsland D. Atypical antipsychotics for the treatment of behavioral and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opin Drug Saf 2011;10:35–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Markowitz JS, Brown CS, Moore TR. Atypical antipsychotics. Part I: pharmacology, pharmacokinetics, and efficacy. Ann Pharmacother 1999;33:73–85.PubMedCrossRefGoogle Scholar
  8. 8.
    Gareri P, De Fazio P, De Fazio S, Marigliano N, Ferreri Ibbadu G, De Sarro G. Adverse effects of atypical antipsychotics in the elderly: a review. Drugs Aging 2006;23:937–956.PubMedCrossRefGoogle Scholar
  9. 9.
    Gardner D, Baldessarini R.J, Waraich P. Modern antipsychotic agents: A brief overview. Can Med Assoc J 2005;72:1703–1711.CrossRefGoogle Scholar
  10. 10.
    Carson S, McDonagh MS, Peterson K. A systematic review of the efficacy and safety of atypical antipsychotics in patients with psychological and behavioral symptoms of dementia J Am Geriatr Soc 2006;54:354–361.PubMedCrossRefGoogle Scholar
  11. 11.
    Chan WC, Lam LC, Choy CN, Leung VP, Li SW, Chiu HF. A double-blind randomised comparison of risperidone and haloperidol in the treatment of behavioural and psychological symptoms in Chinese dementia patients. Int J Geriatr Psychiatry 2001;16:1156–1162.PubMedCrossRefGoogle Scholar
  12. 12.
    De Deyn PP, Rabheru K, Rasmussen A, et al. A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999;53:946–955.PubMedCrossRefGoogle Scholar
  13. 13.
    Brodaty H, Ames D, Snowden J, et al. A randomized placebo controlled trial of risperidone for the treatment of aggression, agitation, and psychosis in dementia. J Clin Psychiatry 2003;64:134–143.PubMedCrossRefGoogle Scholar
  14. 14.
    Lonergan E, Luxenberg J, Colford JM, Birks J. Haloperidol for agitation in dementia. Cochrane Database Syst Rev 2002;(2):CD002852.Google Scholar
  15. 15.
    Maguire GA. Impact of antipsychotics on geriatric patients: efficacy, dosing, and compliance. Prim Care Companion J Clin Psychiatry. 2000:2:165–172.PubMedCrossRefGoogle Scholar
  16. 16.
    Fabbrini G, Barbanti P, Aurilia C. Tardive dyskinesias in the elderly. Int J Geriatr Psychiatry 2001;16:S19–S23.PubMedCrossRefGoogle Scholar
  17. 17.
    Wirshing WC. Movement disorders associated with neuroleptic treatment. J Clin Psychiatry 2001;62:15–18.PubMedGoogle Scholar
  18. 18.
    Tarsy D, Baldessarini RJ. Epidemiology of tardive dyskinesia: is risk declining with modern antipsychotics? Mov Disord 2006;21:589–598.PubMedCrossRefGoogle Scholar
  19. 19.
    Yacoub A, Francis A. Neuroleptic malignant syndrome induced by atypical neuroleptics and responsive to lorazepam. Neuropsychiatr Dis and Treat 2006;2:235–240.CrossRefGoogle Scholar
  20. 20.
    Katz I, Jeste DV, Mintzer JE, Clyde C, Napolitano J, Brecher M. Comparison of risperidone and placebo for psychosis and behavioural disturbances associated with dementia: a randomized, double blind trial. J Clin Psychiatry 1999; 60:107–115.PubMedCrossRefGoogle Scholar
  21. 21.
    Bouman WP, Pinner G: Use of atypical antipsychotic drugs in old age psychiatry. Adv Psychiatr Treat 2002;8:49–58.CrossRefGoogle Scholar
  22. 22.
    Landi F, Onder G, Cesari M, Barillaro C, Russo A, Bernabei R. Silver Network Home Care Study Group. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol Biol Sci Med Sci 2005;60:622–626.CrossRefGoogle Scholar
  23. 23.
    HienIe TT, Cumming RG, Sanbroook PN. Atypical antipsychotic medications and risk of falls in residents of aged care facilities. J Am Geriatr Soc 2005;53:1290–1295.CrossRefGoogle Scholar
  24. 24.
    Motsinger CD, Perron GA, Lacy TJ. Use of atypical antipsychotic drugs in patients with dementia. Am Fam Physician 2003;67:2335–2340.PubMedGoogle Scholar
  25. 25.
    Ananth J, Venkatesh R, Burgoyne K, Gadasalli R, Binford R, Gunatilake S. Atypical antipsychotic induced weight gain: pathophysiology and management. Ann Clin Psychiatry 2004;16:75–78.PubMedCrossRefGoogle Scholar
  26. 26.
    Avorn J, Monane M, Everitt DE, Beers MH, Fields D. Clinical assessment of extrapyramidal signs in nursing home patients given antipsychotic medication. Arch Intern Med 1994;154:1113–1117.PubMedCrossRefGoogle Scholar
  27. 27.
    Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmächer T. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 2003;37:193–220.PubMedCrossRefGoogle Scholar
  28. 28.
    Holt RIG, Peveler RC, Byrne CD. Schizophrenia, the metabolic syndrome and diabetes. Diabet Med 2004;21:515–523.PubMedCrossRefGoogle Scholar
  29. 29.
    Akhtar S, Kelly C, Gallagher A, Petrie JR. Newer antipsychotic agents, carbohydrate metabolism and cardiovascular risk. Brit J Diabetes Vasc Dis 2004;4:303–309.CrossRefGoogle Scholar
  30. 30.
    McIntyre RS, Mancini DA, Basile VS, Srinivasan J, Kennedy SH. Antipsychoticinduced weight gain: bipolar disorders and leptin. J Clin Psychopharmacol 2003;23:323–327.PubMedCrossRefGoogle Scholar
  31. 31.
    Haupt DW, Newcomer JW. Hyperglycemia and antipsychotic medications. J Clin Psychiatry 2001;62:15–26.PubMedGoogle Scholar
  32. 32.
    Sowell MO, Mukhopadhyay N, Cavazzoni P, et al. Hyperglycemic clamp assessment of insulin secretory responses in normal subjects treated with olanzapine, risperidone, or placebo. J Clin Endocrinol Metab 2002;87:2918–2923.PubMedCrossRefGoogle Scholar
  33. 33.
    American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry 2004;65:267–272.CrossRefGoogle Scholar
  34. 34.
    Casey DE. Dyslipidemia and atypical antipsychotic drugs. J Clin Psychiatry 2004;65:27–35.PubMedGoogle Scholar
  35. 35.
    Alberti KG, Zimmet P, Shaw J. The IDF Epidemiology Task Force Consensus Group. The metabolic syndrome — a new worldwide definition. Lancet 2005;366:1059–1062.PubMedCrossRefGoogle Scholar
  36. 36.
    Lieberman JA. Metabolic changes associated with antipsychotic use. Prim Care Companion Clin Psychiatry 2004;6:8–13.Google Scholar
  37. 37.
    Rosack J. FDA to require diabetes warning on antipsychotics. Psychiatr News 2003;38:1.Google Scholar
  38. 38.
    Show 28: warning about hyperglycemia and atypical antipsychotic drugs [webcast]. FDA Safety News. June, 2004.
  39. 39.
    Dalton SO, Johansen C, Poulsen AH, et al. Cancer risk among users of neuroleptic medication: a population-based cohort study. Brit J Cancer 2006;95:934–939.PubMedCrossRefGoogle Scholar
  40. 40.
    Wang PS, Walker AM, Tsuang MT, et al. Dopamine antagonists and the development of breast cancer. Arch Gen Psychiatry 2002:59:1147–1154.PubMedCrossRefGoogle Scholar
  41. 41.
    Liperoti R, Pedone C, Lapane KL, Mor V, Bernabei R, Gambassi G. Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents. Arch Intern Med 2005;165:2677–2682.PubMedCrossRefGoogle Scholar
  42. 42.
    Love RC. Novel versus conventional antipsychotic drugs. Pharmacotherapy 1996;16:6–10.PubMedGoogle Scholar
  43. 43.
    Hagg S, Spigset O, Söderström TG. Association of venous thromboembolism and clozapine. Lancet 2000;355:1155–1156.PubMedCrossRefGoogle Scholar
  44. 44.
    Lieberman JA. Managing anticholinergic side effects. Prim Care J Clin Psychiatry 2004;6:20–23.Google Scholar
  45. 45.
    Byerly MJ, Weber MT, Brooks DL, Snow LR, Worley MA, Lescouflair E. Antipsychotic medications and the elderly: effects on cognition and implications for use. Drugs Aging 2001;18:45–63.PubMedCrossRefGoogle Scholar
  46. 46.
    Summary of clinical trial data on cerebrovascular adverse events (CVAEs) in randomized clinical trials of risperidone conducted in patients with dementia. London, UK. Medicines and Healthcare Products Regulatory Agency, 2004.Google Scholar
  47. 47.
    Douglas IJ. Exposure to antipsychotics and risk of stroke: self controlled case series study. Brit Med J 2008;1227–1232.Google Scholar
  48. 48.
    Sacchetti E, Trifiro G, Caputi A, et al. Risk of stroke with typical and atypical antipsychotics: a retrospective cohort study including unexposed subject. J Psychopharmacol 2008; 22: 39–46.PubMedCrossRefGoogle Scholar
  49. 49.
    Gill SS, Rochon PA, Herrmann N, et al. Atypical antipsychotic drugs and risk of ischemic stroke: population based retrospective cohort study. BMJ, 2005 doi:10.1136/bmj.38330.470486.8F (Epub 2005 January 24).Google Scholar
  50. 50.
    Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotics and the risk of sudden cardiac death. N Engl J Med 2009;360:225–235.PubMedCrossRefGoogle Scholar
  51. 51.
    Schneeweiss S, Avorn J. Antipsychotic agents and sudden cardiac death — how should we manage the risk? N Engl J Med 2009;360;294–296.PubMedCrossRefGoogle Scholar
  52. 52.
    Liperoti R, Gambassi G, Lapane KL, et al. Conventional and atypical antipsychotics and the risk of hospitalization for ventricular arrhythmias or cardiac arrest Arch Intern Med 2005;165:696–701.PubMedCrossRefGoogle Scholar
  53. 53.
    FDA-US. Food and Drug Administration: 2009 Public Health Advisories: Deaths with antipsychotics in elderly patients with behavioral disturbances. Available at:
  54. 54.
    Kales HC, Valenstein M, Kim HM, et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry 2007;164:1568–1576.PubMedCrossRefGoogle Scholar
  55. 55.
    Gill SS, Bronskill SE, Normand SL, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Inter Med 2007;146:775–786.Google Scholar
  56. 56.
    Schneeweiss S, Setoguchi S, Brookhart A, Dormuth C, Wang PS. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. Can Med Assoc J 2007;176:627–632.CrossRefGoogle Scholar
  57. 57.
    Huybrechts KF, Rothman KJ, Silliman RA, Brookhart MA, Schneeweiss S. Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes. Can Med Assoc J 2011;183:E411–E419.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2012

Authors and Affiliations

  • A. Gurevich
    • 1
    • 5
  • V. Guller
    • 2
    • 5
  • Y. N. Berner
    • 3
    • 6
  • S. Tal
    • 2
    • 4
    Email author
  1. 1.Geriatrics Department, Hartzfeld HospitalKaplan Medical CenterGederaIsrael
  2. 2.Geriatric Medicine DepartmentKaplan Medical CenterRehovotIsrael
  3. 3.Department of Geriatric MedicineMeir Medical CenterKfar SabaIsrael
  4. 4.Geriatric Medicine DepartmentKaplan Medical CenterRehovotIsrael
  5. 5.Hebrew University of JerusalemJerusalemIsrael
  6. 6.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

Personalised recommendations