Addressing the Controversial Use of Antipsychotic Drugs for Behavioral and Psychological Symptoms of Dementia

Abstract

Objective:

To review relevant background information on behavioral and psychological symptoms of dementia (BPSD) and the antipsychotic drugs used to treat it, describe benefits versus risks of antipsychotic drugs for treatment of BPSD, and describe the latest management guidelines for patients with BPSD.

Data Sources:

A PubMed literature search (1998–October 2011) was conducted using the following MeSH search terms: dementia, elderly, antipsychotics, behavioral symptoms, and psychological symptoms. Tertiary references and prescribing information for included medications were used for pharmacology, adverse effects, and cost.

Data Selection and Data Extraction:

English-language reviews, tertiary references, and guidelines were reviewed; only articles that used pharmacotherapy in human models were included.

Data Synthesis:

There are no FDA-approved medications for treatment of BPSD; several classes of drugs are prescribed off-label, including selective serotonin reuptake inhibitors and certain anticonvulsants. Antipsychotics, particularly those from the atypical class, are also commonly used by clinicians as a pharmacologic intervention for dementia. Yet, since these are drugs with a wide array of potentially serious adverse effects, including increased risk for cerebrovascular accidents, clinicians treating patients with dementia must be especially cognizant of the benefits and risk of their use.

Conclusions:

Nonpharmacologic treatments should be first-line therapy for BPSD. When these approaches do not produce the desired results, clinicians must weigh the risks versus benefits of continued psychological disease and dangerous behavior with the use of an antipsychotic drug regimen.