Antipsychotic Pharmacotherapy for Neuropsychiatric Symptoms of Dementia
Purpose of Review
Antipsychotic medications are routinely prescribed for neuropsychiatric symptoms (NPS) associated with dementia, despite conflicting evidence regarding their safety and comparative effectiveness for this population. The purpose of this review is to examine the efficacy and comparative effectiveness of first and second-generation antipsychotics (SGAs) for the treatment of agitation, psychosis, and overall NPS in patients with Alzheimer’s disease and related dementias.
There is a paucity of high quality, randomized controlled clinical trials examining the efficacy of antipsychotic medications on NPS under randomized, placebo-controlled, and double-blind conditions. Based on our review, risperidone has the best evidence for the management of agitation and psychosis, with aripiprazole exhibiting better evidence compared to SGAs as a class for overall NPS, with both drugs exhibiting only a small effect.
Current research demonstrates that antipsychotic medications are not particularly effective for the management of NPS of dementia and carry a substantial side effect burden. Although further research is needed to fully determine the safety, tolerability, and efficacy of these treatments, there is a need to develop safe and effective pharmacological and nonpharmacologic interventions for this population.
KeywordsNeuropsychiatric symptoms Antipsychotics Alzheimer’s disease dementia Agitation Aggression Psychosis
Compliance with Ethical Standards
Conflict of Interest
Dr. Golas has no conflict of interest.
Dr. Fischer has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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