title: Behavioral Disorders in Dementia: Appropriate Nondrug Interventions and Antipsychotic Use.
abstract: Behavioral and psychological symptoms of dementia pose management challenges for caregivers and clinicians. Firstline nonpharmacologic treatments include eliminating physical and emotional stressors, modifying the patient's environment, and establishing daily routines. Family members and caregivers benefit from education about dementia symptoms and reminders that the behaviors are normal and unintentional. Cognitive and emotion-oriented interventions, sensory stimulation interventions, behavior management techniques, and other psychosocial interventions are modestly effective. In refractory cases, physicians may choose to prescribe off-label antipsychotics. Aripiprazole has the most consistent evidence of symptom improvement; however, this improvement is small. Olanzapine, quetiapine, and risperidone have inconsistent evidence of benefit. Physicians should use the smallest effective dose for the shortest possible duration to minimize adverse effects, most notably an increased mortality risk. Other adverse effects include anticholinergic and antidopaminergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, postural hypotension, metabolic syndrome, cardiac arrhythmia, and sedation. Patients should be monitored for these effects while receiving treatment; however, laboratory monitoring may be limited to patients receiving long-term therapy.
authors.affiliation: Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Reese
authors.affiliation: Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Derrick J
authors.initials: DJ
authors.lastname: Thiel
authors.affiliation: Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Cocker
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D001521:Behavior Therapy; D001569:Benzodiazepines / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D024821:Metabolic Syndrome / Q000139:chemically induced; D009459:Neuroleptic Malignant Syndrome / Q000209:etiology; D000077152:Olanzapine; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D018967:Risperidone / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine