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Antipsychotic Pharmacotherapy for Neuropsychiatric Symptoms of Dementia

  • Schizophrenia and Other Psychotic Disorders (J Csernansky, Section Editor)
  • Published:
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Abstract

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.

Recent Findings

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.

Summary

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.

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Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Angela C. Golas MD, FRCPC & Corinne E. Fischer MD, FRCPC

  2. Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, 80 Workman Way, 6th floor, Room 6218, Toronto, ON, M6J 1H4, Canada

    Angela C. Golas MD, FRCPC

  3. Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Room CCS 17-044, Toronto, ON, M5B 1W8, Canada

    Angela C. Golas MD, FRCPC & Corinne E. Fischer MD, FRCPC

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Golas, A.C., Fischer, C.E. Antipsychotic Pharmacotherapy for Neuropsychiatric Symptoms of Dementia. Curr Treat Options Psych 5, 56–72 (2018). https://doi.org/10.1007/s40501-018-0139-z

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