Amisulpride in Refractory Behavioral and Psychological Symptoms of Dementia

Abstract

olanzapine, quetiapine and risperidone. There are many patients who fail to respond to these drugs [9], leaving a window for the new entry [1]. Since a sizable number of patients do not adequately respond to the available drugs [1,[9][10][11][12], drugs such as ramelteon [9] and carbamazepine [11] Amisulpride is a second generation atypical antipsychotic that selectively binds to dopamine D 2 /D 3 receptors with 5-HT 7 antagonistic effect in the limbic system of the brain [14,15]. Amisulpride has not IntroductionDementia is a common disease of the elderly and is characterized by cognitive and non-cognitive complaints [1]. Dementias involves loss of cognitive abilities and at least one of the following e.g., aphasia, apraxia, agnosia, disturbances in executive functioning [2]. The behavioural impairment in dementia interferes with a person's Activity of Daily Living [3]. It is a common cause of caregiver stress and burden and leads to poor Quality of Life [4]. Psychosis is the most common disturbance in patients with dementias with behavioral and psychological symptoms of dementia (BPSD) [5], which affects up to 90% of all dementia subjects [6]. Psychotic BPSD include verbal and physical aggression, agitation, hallucinations delusions, irritability, sleep disturbances, oppositional behaviors, and wandering type behaviors [7] etc. Course of dementias is complicated by the occurrence of BPSD [1] and is the single most predictor of hospitalization and caregiver stress [5].Currently, the antipsychotics are the most commonly offlabel drugs used in the management of BPSD [8]. These have been the mainstay of the treatment of BPSD, especially the psychotic behaviours. The commonly used drugs for this purpose include AbstractBackground: Amisulpiride is an atypical antipsychotic used extensively in Schizophrenia and related disorders. The current study explored the safety and tolerability of amisulpride in refractory patients with behavioral and psychological symptoms of dementia (BPSD), especially in agitation and/ or aggression.

Cardiovascular Comorbidities and Cognitive Impairment

“…Cardiovascular factors have been reported in other neurodegenerative diseases as well, such as Parkinson's disease [17,18]. These have also been associated with behavioral and psychological symptoms of dementias [19] and hippocampal atrophy, one of the earliest and most severely affected structures [19][20][21][22][23][24][25][26][27]. Perhaps hormones such as glucocorticoids synergize with vascular factors in causing vascular damage [28].…”