Are atypical antipsychotics safer than typical antipsychotics for treating behavioral and psychological symptoms of dementia?

The Journal of Nutrition, Health & Aging Volume 16, Number 6, 2012

ARE ATYPICAL ANTIPSYCHOTICS SAFER THAN TYPICAL ANTIPSYCHOTICS FOR TREATING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS

OF DEMENTIA?

A. GUREVICH1, V. GULLER2, Y.N. BERNER3, S. TAL2

1. Geriatrics Department, Hartzfeld Hospital, Kaplan Medical Center, Gedera, affiliated with the Hebrew University of Jerusalem, Israel; 2. Geriatric Medicine Department, Kaplan Medical Center, Rehovot, affiliated with the Hebrew University of Jerusalem, Israel; 3. Department of Geriatric Medicine, Meir Medical Center, Kfar Saba, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel. Corresponding author: S. Tal, MD, Geriatric Medicine Department, Kaplan Medical Center, Rehovot, Israel, Tel. [phone], Fax: [phone], Email: [email protected]

Abstract: Atypical antipsychotics seem to be preferable than conventional agents in treating psychological symptoms of dementia (BPSD), because they have substantially lower risks of extrapyramidal neurological effects with lower reported rates of parkinsonism and tardive dyskinesia. However, in the course of time, with the increase in their use, more and more side effects have been reported. The benefits and risks of antipsychotic treatment should be carefully evaluated according to the co-morbidity and the severity of the psychological and behavioral symptoms and their impact on the individual elderly patient. It is recommended to keep those medications in the lower range of therapeutic doses. Due to the complexity of the individual patient, no guidelines have been yet established. Therefore, clinical judgment should be used in applying the dose and the type of those drugs.

Key words: Elderly, dementia, conventional antipsychotics, atypical antipsychotics, BPSD.

Introduction

A majority of elderly patients with dementia develop, during the course of their disease, aggression, delusions, and other neuropsychiatric symptoms (1). Behavioral and psychological symptoms of dementia (BPSD) are associated with an increased caregiver burden, an accelerated cognitive decline, earlier institutionalization and excess mortality (2). Management of (BPSD) has not been standardized, and includes pharmacological and non-pharmacological approaches (1). Pharmacological treatment is recommended to be used only when non-pharmacologic approaches have failed to adequately control the symptoms of BPSD (2). Use of antipsychotics in older patients is complicated, because concomitant co-morbid conditions, side effects and combinations of various medications should be taken into consideration. For many years, conventional (typical) antipsychotics have been the mainstay of pharmacotherapy for BPSD. These drugs have potentially serious adverse...