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my personal edition > alzheimer's > news
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DGReview
Atypical Antipsychotic Drugs Effective for Elderly Patients with Dementia
A DGReview of :"Use of Atypical Antipsychotic Drugs in Patients with Dementia"
American Family Physician
06/25/2003
By Deanna M Green
Knowledgeable administration of atypical antipsychotic drugs can improve quality of life in elderly patients with dementia and behaviour disturbances, according to a recent review of this type of treatment.
Symptoms of psychosis and behavioural disturbances are often experienced by elderly patients with Alzheimer's disease, other dementias, or Parkinson's disease. Antipsychotic medications can be prescribed to treat these symptoms; however these drugs can be somewhat less familiar to family physicians.
Haloperidol (Haldol) is a typical antipsychotic drug that has been administered to patients experiencing psychotic and behaviour disturbances. Unfortunately though, it is known to have adverse side effects in elderly patients, such as stiffness, immobility, and falls and is associated with increased morbidity.
The National Institutes of Health have estimated that there will be 8.5 million Americans with Alzheimer's disease by the year 2030, thereby increasing the need for safer and more effective treatments of associated psychotic and behavioural disturbances.
Captain Charles D. Motsinger, USAF, MC, and colleagues at Andrews Air Force Base in Maryland, United States, reviewed the effectiveness of atypical antipsychotic drugs in patients with dementia.
Initially, the potential therapeutic effect of nonpharmacologic treatments such as the use of familiar objects, maintenance of sleep-wake cycles, redirection, and frequent reorienting should be explored before prescribing antipsychotic drugs. However once medication is deemed necessary, several options are available.
Clinical studies have indicated that risperidone (Risperdal) and olanzapine (Zyprexa) are most highly recommended for the treatment of Alzheimer's related dementia, while quetiapine (Seroquel) and clozapine are more effective for the treatment of psychosis in Parkinson's patients.
The effectiveness of ziprasidone (Geodon), another recently approved antipsychotic agent, is still under investigation.
Common side effects experienced in patients taking these drugs include insomnia, orthostatic hypotension, weight gain, sedation, seizures, headache and extrapyramidal symptoms. These adverse effects are most commonly seen when patients are given higher doses of medication.
In addition to these effects, clozapine is also known to cause potentially lethal side effects such as agranulocytosis, with a fatality rate up to 30%. Clozapine is therefore only recommended after other treatment options have failed.
There is also an increasing concern due to reports of hyperglycaemia independent of weight gain in patients who are taking certain atypical antipsychotic drugs. It has therefore also been proposed that patients taking these drugs should be screened for diabetes twice a year.
From this review, Captain Motsinger concludes that "informed use of atypical antipsychotic drugs allows family physicians to greatly improve quality of life in elderly patients with dementia and behaviour disturbances."
Am Fam Physician 2003;67:11:2335-40.
"Use of Atypical Antipsychotic Drugs in Patients with Dementia"
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