Pharmacotherapy of behavioral and psychological symptoms of dementia: a review of atypical antipsychotics.
OBJECTIVE
To review the literature on use of antipsychotics to treat behavioral and psychological symptoms of dementia (BPSD).


METHODS
Information was selected from a MEDLINE search of English-language medical literature using the search terms "antipsychotics" and "elderly." Manual searches of pertinent journal article references, and review of poster presentations at recent professional meetings were also performed.


METHODS
Meta-analyses published in 1990 and 1998 were used as a starting point for information about conventional antipsychotics. Articles reporting the results of controlled trials of conventional antipsychotics published since the second meta-analysis (October 1998) were included. Also included were articles reporting the results of controlled clinical trials of atypical antipsychotics (i.e., clozapine, risperidone, olanzapine, quetiapine, ziprasidone) for the treatment of dementia in the elderly. Studies and post hoc analyses of special patient populations (Parkinson's disease, schizophrenia, treatment-refractory BPSD) were excluded. One open-label extension and one post hoc analysis were included because they provide valuable information about the long-term use of atypical antipsychotics. One poster was included, as it contained the only data available from a controlled trial of quetiapine.


METHODS
Data were extracted from the literature, as well as a recent scientific poster presentation. Two meta-analyses and six controlled studies were identified for inclusion.


RESULTS
There are few controlled clinical trials of the use of antipsychotics in elderly patients with dementia. Currently available information indicates these medications are useful in the treatment of behavioral and psychological symptoms of dementia, but the clinician must exercise caution because of the drugs' potential side effects.


CONCLUSIONS
While widely prescribed on an "off-label" basis, there is a dearth of placebo-controlled clinical trials necessary to evaluate safety, and head-to-head comparative studies necessary to contrast efficacy and safety of atypical antipsychotics in treating BPSD.
Pharmacotherapy Solutions, Orlando, Florida 32803, USA. ldaiello@cfl.rr.com
Lori A
LA
Daiello
Manju T
MT
Beier
Vicki Poole
VP
Hoffmann
John S
JS
Kennedy