Drugs & Aging

, Volume 25, Issue 5, pp 381–398 | Cite as

Alternatives to Atypical Antipsychotics for the Management of Dementia-Related Agitation

  • Michael J. Passmore
  • David M. Gardner
  • Yvette Polak
  • Kiran Rabheru
Review Article

Abstract

Numerous recent studies have challenged the widely held belief that atypical antipsychotics are safe and effective options for the treatment of behavioural problems such as agitation in patients with dementia. Accordingly, there is a need to reconsider the place of atypical antipsychotics in the treatment of patients with dementia. The present article is intended to assist clinicians with the assessment and pharmacological management of agitation in patients with dementia. We review the risk-benefit evidence for the use of atypical antipsychotics in patients with dementia-related agitation (DRA). Emerging evidence indicates that, for patients with dementia, the risks associated with atypical antipsychotics may outweigh the benefits except for patients with severe agitation who require short-term chemical restraint. We then discuss the importance of a careful assessment to rule out potentially reversible factors contributing to DRA. Finally, we summarize the evidence supporting the use of medications other than antipsychotics to treat DRA. There is wide variability in the levels of evidence supporting the use of nonantipsychotic medication for the treatment of DRA. The best evidence currently exists for cholinesterase inhibitors and serotonin-specific reuptake inhibitor antidepressants. Emerging reports suggest that numerous other medications, for example, antiepileptics, lithium, anxiolytics, analgesics, β-adrenoceptor antagonists, cannabinoid receptor agonists and hormonal agents, may prove to be viable alternatives to antipsychotics for the treatment of severe DRA and more research is urgently needed to help assess the effectiveness of these agents. A comprehensive biopsychosocial assessment and treatment plan is likely the most effective way to manage DRA.

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this review. Dr Passmore received an honorarium for participating in a 2005 Novartis advisory board meeting. Dr Gardner has received in the last 5 years consultancy fees, honoraria and grants from the manufacturers of patented and non-patented antipsychotic agents, including Pfizer and AstraZeneca. Dr Rabheru has received in the last 5 years honoraria and/or consulting fees from Pfizer, Janssen, Novartis, Wyeth, Organon and Lundbeck, grants from Pfizer, Janssen and Wyeth and has a grant pending from Lundbeck. Dr Polak has no conflicts of interest that are directly relevant to the content of this review.

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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Michael J. Passmore
    • 1
  • David M. Gardner
    • 2
  • Yvette Polak
    • 3
  • Kiran Rabheru
    • 1
  1. 1.Department of Psychiatry, Division of Geriatric PsychiatryUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Psychiatry and College of PharmacyDalhousie UniversityHalifaxCanada
  3. 3.Department of PsychiatryUniversity of AlbertaEdmontonCanada

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