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Risperidone Helps Reduce Psychosis in Alzheimer's Patients: Presented at AGS

By Roberta Friedman

LAS VEGAS, NV -- May 20, 2004 -- The atypical antipsychotic drug risperidone was more effective than placebo for the psychotic and aggressive symptoms that are associated with Alzheimer's disease, according to a poster presented here May 18^th at the American Geriatric Society Annual Meeting.

Agitation also responded to doses of the drug tested, which ranged from 0.5 mg to 2.0 mg a day, but hallucinations did not.

Study investigator Ira Katz, MD, Professor of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, said these are important symptoms "because they lead to caregiver burden, and increase the risk of nursing home placement."

The study included 690 patients with Alzheimer's disease with symptoms of psychosis; 436 were randomized to receive risperidone and 254 to placebo. The Behavioral Pathology in Alzheimer's Disease (BEHAV-AD) rating scale provided indices of paranoid and delusional ideation, activity disturbances, and aggressiveness. Also, the Cohen-Mansfield Agitation Inventory scored physical and verbal aggression.

Statistically significant reductions appeared with risperidone for all but hallucination scores over the 12 weeks of follow up.

Safety is an issue with this class of agents, Dr. Katz said. Elderly patients given the drugs can develop extrapyramidal symptoms. But this adverse effect and sedation are easily dealt with by discontinuing the drug, he said.

There is a greater risk of stroke or temporary ischemic events with antipsychotic agents, which are seen in 1% to 2% of elderly patients with Alzheimer's who take these agents, Dr. Katz said. Prior studies also showed a 1% risk of aspiration with olanzapine, probably due to its sedating effect, he said.

"The task for the doctor is how to decide... if the risk of treatment is less than the risk of non treatment," Dr. Katz said. "If the patient is wandering and shouting in the halls of the nursing home," the decision to add risperidone is not straightforward. However, he said, the drug should clearly be added to treatment "if the patient is slugging the spouse."

Janssen supported the research.


[Presentation title: "Risperidone is effective in the treatment of behavioural and psychological symptoms in patients with psychosis of Alzheimer's disease and related dementias." Abstract #450.]

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