Clinical experience with risperidone in the treatment of behavioral and psychological symptoms of dementia

Onor, Maria Luisa; Saina, M.; Trevisiol, Marianna; Cristante, Tania; Aguglia, Eugenio

doi:10.1016/j.pnpbp.2006.09.001

Cited by 18 publications

(9 citation statements)

References 27 publications

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“…There is emerging evidence that poor sleep may contribute to the development of AD and impair memory function . Options for effective pharmacological treatment of insomnia in AD are limited, with inconsistent or poor‐quality evidence for efficacy of melatonin, second‐generation antipsychotics (which are primarily used to target other neuropsychiatric and behavioral symptoms associated with AD), and sedating antidepressants . Furthermore, potential for adverse events and worsening of cognitive impairment and functional decline is an important concern in treating sleep problems in patients with AD using antipsychotics and sedatives …”

Section: Introductionmentioning

confidence: 99%

Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: a randomized trial

Herring

Ceesay

Snyder

et al. 2020

Alzheimer's & Dementia

111

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Introduction We evaluated the clinical profile of the orexin receptor antagonist suvorexant for treating insomnia in patients with mild‐to‐moderate probable Alzheimer's disease (AD) dementia. Methods Randomized, double‐blind, 4‐week trial of suvorexant 10 mg (could be increased to 20 mg based on clinical response) or placebo in patients who met clinical diagnostic criteria for both probable AD dementia and insomnia. Sleep was assessed by overnight polysomnography in a sleep laboratory. The primary endpoint was change‐from‐baseline in polysomnography‐derived total sleep time (TST) at week 4. Results Of 285 participants randomized (suvorexant, N = 142; placebo, N = 143), 277 (97%) completed the trial (suvorexant, N = 136; placebo, N = 141). At week 4, the model‐based least squares mean improvement‐from‐baseline in TST was 73 minutes for suvorexant and 45 minutes for placebo; (difference = 28 minutes [95% confidence interval 11‐45], p < 0.01). Somnolence was reported in 4.2% of suvorexant‐treated patients and 1.4% of placebo‐treated patients. Discussion Suvorexant improved TST in patients with probable AD dementia and insomnia.

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Section: Introductionmentioning

confidence: 99%

Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: a randomized trial

Herring

Ceesay

Snyder

et al. 2020

Alzheimer's & Dementia

111

View full text Add to dashboard Cite

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“…These NPS are highly associated with caregiver burnout ( 30 ), frequently leading to institutionalization ( 31 ) as their management usually needs pharmacological treatment supported by non-pharmacological interventions. However, despite efficacy in the reduction of most of these challenging symptoms by antipsychotics ( 32 ), they should not be used routinely for the treatment of aggression and psychosis in these patients because they have an associated increased risk of cerebrovascular accidents, respiratory diseases, and mortality ( 33 – 35 ). Unfortunately, at a practical level, the medication reviews are infrequent, and antipsychotics are used on a long-term basis despite their higher mortality risk ( 36 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of Social Isolation on the Behavioral, Functional Profiles, and Hippocampal Atrophy Asymmetry in Dementia in Times of Coronavirus Pandemic (COVID-19): A Translational Neuroscience Approach

Muntsant

Giménez-Llort

2020

Front. Psychiatry

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The impact of COVID-19 on the elderly is devastating, and nursing homes are struggling to provide the best care to the most fragile. The urgency and severity of the pandemic forces the use of segregation in restricted areas and confinement in individual rooms as desperate strategies to avoid the spread of disease and the worst-case scenario of becoming a deadly trap. The conceptualization of the post–COVID-19 era implies strong efforts to redesign all living conditions, care/rehabilitation interventions, and management of loneliness forced by social distance measures. Recently, a study of gender differences in COVID-19 found that men are more likely to suffer more severe effects of the disease and are over twice as likely to die. It is well-known that dementia is associated with increased mortality, and males have worse survival and deranged neuro-immuno-endocrine systems than females. The present study examines the impact of long-term isolation in male 3xTg-AD mice modeling advanced stages of Alzheimer's disease (AD) and as compared to age-matched counterparts with normal aging. We used a battery of ethological and unconditioned tests resembling several areas in nursing homes. The main findings refer to an exacerbated (two-fold increase) hyperactivity and emergence of bizarre behaviors in isolated 3xTg-AD mice, worrisome results since agitation is a challenge in the clinical management of dementia and an important cause of caregiver burden. This increase was consistently shown in gross (activity in most of the tests) and fine (thermoregulatory nesting) motor functions. Isolated animals also exhibited re-structured anxiety-like patterns and coping-with-stress strategies. Bodyweight and kidney weight loss were found in AD-phenotypes and increased by isolation. Spleen weight loss was isolation dependent. Hippocampal tau pathology was not modified, but asymmetric atrophy of the hippocampus, recently described in human patients with dementia and modeled here for the first time in an animal model of AD, was found to increase with isolation. Overall, the results show awareness of the impact of isolation in elderly patients with dementia, offering some guidance from translational neuroscience in these times of coronavirus and post–COVID-19 pandemic. They also highlight the relevance of personalized-based interventions tailored to the heterogeneous and complex clinical profile of the individuals with dementia and to consider the implications on caregiver burden.

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“…Onor et al. administered risperidone to an AD patient starting at a dose of 0.5 mg/day 7 . The dose of risperidone was increased 0.5 mg/day every 3 days to improve symptoms, with the patient receiving a final dose of 1 mg/day risperidone 7 .…”

Section: Discussionmentioning

confidence: 99%

Beneficial and adverse effects of pharmacotherapy with risperidone on behavioral and psychological symptoms of dementia (BPSD)

Oshima¹

2008

Psychogeriatrics

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Background: Behavioral and psychological symptoms of dementia (BPSD) increase the burden of caregiving. In 2004, the US Food and Drug Administration issued a warning on an increase in the mortality rate in elderly patients using antipsychotics. Thereafter, although the need for antipsychotics for BPSD has increased, discussions regarding their indication have continued.Methods: The present study was performed in 18 patients with Alzheimer's disease (AD) and patients with vascular dementia (VaD) who were treated with risperidone because of BPSD. Changes in the dose of risperidone and the beneficial and adverse effects of risperidone were evaluated for 3 months after the start of antipsychotic therapy. Results: The mean starting dose of risperidone was 0.62 1 0.30 mg (62 1 30 mg chlorpromazine (CP) equivalents), which, after 3 months, increased to 0.99 1 0.49 mg risperidone (99 1 49 mg CP equivalents). The symptoms of BPSD at the beginning of treatment were delusions (48% of patients) and violence (22% of patients). In the 3-month treatment period, an improvement in BSPD symptoms was recorded in 78% of patients. During the study period, adverse effects were observed in 65% of patients: 26% of patients reported falling and extrapyramidal symptoms were seen in 13%. There were no cardiovascular events or deaths. Conclusion: In the present study, low doses of risperidone were used for the treatment of BPSD and no serious side-effects were observed. An atypical antipsychotic can be one of the treatment options if a thorough risk assessment of the cardiovascular system is made and informed consent is obtained.

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Clinical experience with risperidone in the treatment of behavioral and psychological symptoms of dementia

Cited by 18 publications

References 27 publications

Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: a randomized trial

Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: a randomized trial

Impact of Social Isolation on the Behavioral, Functional Profiles, and Hippocampal Atrophy Asymmetry in Dementia in Times of Coronavirus Pandemic (COVID-19): A Translational Neuroscience Approach

Beneficial and adverse effects of pharmacotherapy with risperidone on behavioral and psychological symptoms of dementia (BPSD)

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