Antipsychotics in Alzheimer's disease: A critical analysis

Abstract

The estimated worldwide prevalence of dementia among adults older than 60 years of age was 3.9% in 2005. About 90% of demented patients will develop neuropsychiatric symptoms (NS) such as delirium, delusion, aggressiveness and agitation. The treatment of NS involves non-pharmacologic strategies (with varying degrees of success according to the scientific literature) and pharmacologic treatment (PT). The present review of literature examined the current role of AP in the management of NS in dementia.MethodsA thematic review of medical literature was carried out.Results313 articles were found, 39 of which were selected for critical analysis. Until 2005, the best evidence for PT had supported the use of selective serotonin re-uptake inhibitors (SSRIs), anticholinesterases, memantine and antipsychotics (AP). In 2005, the U.S. Food and Drug Administration (FDA) disapproved the use of atypical APs to treat neuropsychiatric symptoms in individuals with dementia (the same occurred with the typical APs in 2008). After this, at least two important randomized placebo-controlled multicenter trials were published examining the effectiveness of atypical APs in Alzheimer’s disease (CATIE-AD) and the effects of interrupting AP treatment (DART-AD).ConclusionsBased on the current evidence available, APs still have a place in treatment of the more serious psychotic symptoms, after the failure of non-pharmacological treatment and of an initial approach with selective inhibitors of serotonin uptake, anticholinesterases and memantine.

Quetiapine and novel PDE10A inhibitors potentiate the anti-BuChE activity of donepezil

“…For instance, SSRIs were found to be effective in the control of anxiety and depression; however, no significant difference was found between the efficacy of citalopram and risperidone for the treatment of either agitation or psychotic symptoms in subjects suffering from dementia. The authors conclude that these results need to be further confirmed before citalopram or other SSRI can be recommended as an option to antipsychotics for the treatment of agitation or psychotic symptoms associated with dementia 27 , 28 . In turn, Cummings et al.…”

“…Kinetic parameters of BuChE enzymatic reaction. for the treatment of agitation or psychotic symptoms associated with dementia 27,28 . In turn, Cummings et al 29 claim that results of numerous clinical trials of cholinesterase inhibitors and memantine confirm that the treatment offers behavioural benefits 29 .…”

“…It has been estimated that approximately 90% of demented patients, including those suffering from AD, develop neuropsychiatric symptoms such as delusion, aggressiveness and agitation 27 . The treatment of AD-related neuropsychiatric symptoms has been an area of extensive research in recent years.…”

“…As reviewed by Silva et al. 27 , some non-pharmacological strategies, such as music, aromatherapy, and pet therapy, have been applied to alleviate neuropsychiatric symptoms; however, their efficacy is disputable 27 . Regarding pharmacological interventions, a number of drug classes can be used: benzodiazepines, anticholinesterases, antidepressants such as selective serotonin re-uptake inhibitors (SSRI), mood stabilisers, anticonvulsants and antipsychotics 28 .…”