Efficacy and Tolerability of Quetiapine in the Treatment of Behavioral and Psychological Symptoms of Dementia

Abstract

Behavioral symptoms start to appear in mild and moderate dementia and become increasingly severe with the progression of the disease. Agitation, aggressiveness, and psychosis can be seen in Alzheimer's disease, and in particular are common manifestations in Lewy body dementia. It is the behavioral disturbances rather than the cognitive disorders that are more often the cause of the institutionalization of these patients because of the heavy assistance and emotional burden they represent for caregivers. Traditionally, these kinds of symptoms were controlled by classical antipsychotic agents, which after long-term use cause severe extrapyramidal effects, late dyskinesia, sedation, orthostatic hypotension, and cognitive function impairment. More recently, atypical antipsychotic agents have shown a better tolerability profile, with a reduced incidence of extrapyramidal effects, orthostatic hypotension, sedation, and a reduced impact on cognitive function. The aim of this study is to evaluate the efficacy and tolerability of quetiapine in a group of patients with a diagnosis of dementia and concomitant psychotic disorders. The response to treatment was evaluated by the Neuropsychiatric Inventory (NPI) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). The NPI and BEHAVE-AD were administered at baseline and after 4 weeks and 12 weeks of therapy. Tolerability was assessed by the incidence of clinically evident side effects. The results show that quetiapine is effective in reducing behavioral symptoms, deliria and hallucinations, aggressiveness, and sleep disturbances. Quetiapine tolerability proved to be satisfactory. The only side effect of clinical significance was orthostatic hypotension, which was, however, partially preventable by a slower drug titration.

Demonstration of an anti‐oxidative stress mechanism of quetiapine

“…However, anti-oxidants should be recommended to improve cognitive function in schizophrenia and AD patients because oxidative stress is involved in the pathophysiology of these two brain diseases. Quetiapine has both antipsychotic actions and anti-oxidative stress effects, and therefore is beneficial not only for patients with schizophrenia, but also for AD patients with psychiatric and behavioral complications [6,7,[49][50][51]. ThT fluorescence assay Following a method described by LeVine [52], we performed a ThT fluorescence assay.…”

“…and Parkinson's disease (PD), and improves cognitive function in patients with these neurodegenerative diseases [5][6][7][8]. The therapeutic effects observed in AD and PD patients suggest an unexplored mechanism beyond the antagonistic actions of this drug on dopamine and serotonin receptors in the brain.…”

Wrongly Prescribed Half Tablets in a Swiss University Hospital

“…Most of the small clinical studies used increasing doses, starting at 25 mg/day [35][36][37]. We could only find one Italian study with quetiapine 12.5 mg to initiate treatment in 41 patients with dementia and concomitant psychotic disorders [38]. According to a clinical pharmacist at the UHBS, quetiapine is used offlabel in case of agitation in geriatric patients, in flexible dosing schedules starting at 5 mg/day, with specially produced capsules of 5 mg strength [personal communication, Hospital Pharmacy 2012-10-8].…”

Quetiapine: Treatment for substance abuse and drug of abuse

“…Given the growing list of Food and Drug Administration (FDA)-approved indications for quetiapine 44 and unlabeled uses of quetiapine [45][46][47][48][49][50][51][52][53][54][55][56][57] resulting in increased sales 58 prescribers obviously consider this drug a viable pharmacologic choice for a broad array of patients. Furthermore, mounting evidence supporting quetiapine's utility in treating substance use disorders should also be kept in mind, particularly if further largescale investigations validate a distinct benefit associated with its use in treating abuse and dependence.…”