Five Alzheimer's disease cases with refractory behavioural psychological symptoms of dementia treated with blonanserin

Abstract

The aim of the present study was to determine the efficacy, side-effects and tolerability of blonanserin for treating refractory behavioural psychological symptoms of dementia (BPSD). The present study was a 12-week, prospective, structured clinical trial of blonanserin for the treatment of BPSD. The degree of cognitive function, activities of daily living score, and the degree of BPSD were determined using the Mini-Mental State Examination (MMSE), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI) and the Rating Scale for Aggressive Behaviour in the Elderly (RAGE). The severity of extrapyramidal symptoms was assessed using the Drug-Induced Extrapyramidal Symptoms scale (DIEEPS). Five patients were enrolled. These patients met the NINCDS-ADRDA criteria. The patients were prescribed more than two kinds of existing antipsychotic drugs and were considered refractory cases; the drugs were discontinued because they were ineffectual and side-effects appeared. Each drug was prescribed independently for at least 2 weeks. The mean changes (at baseline and at the last week, respectively) in the MMSE (12.25, 9.25), in the DAD (6.5, 6.75), in the RAGE (5.5, 5.3) and in the DIEEPS (0.5, 1.5) were minimal. The mean changes in the NPI were two or fewer points. Some side-effects (one gait abnormality and one pneumonia) were observed. The results of this preliminary study show that blonanserin does not have adequate efficacy for the treatment of refractory BPSD.

Elderly depression and diffusion tensor imaging

“…In the clinical setting, depression in the elderly needs to be differentially diagnosis from neurodegenerative diseases causing dementia, 3 including Alzheimer's disease, 4 diffuse Lewy body disease, 5 frontotemporal dementia, 6 and Parkinson's disease 7 , but this is sometimes difficult, even with neuropsychological, 8,9 biochemical, 10–12 electrophysiological, 13,14 or brain imaging examinations 15–18 . For dementia patients with depression, effective pharmacological 4 and non‐pharmacological 19–22 interventions are sometimes required to control agitation, irritation, negativism, and violent and suicidal behaviors 11 …”

Editorial: New drugs for Alzheimer's disease in Japan

“…Considering the limitations of the drugs available, clinicians should be prepared for the progression of the disease of the patients in the long run. Controlling of behavioral and psychological symptoms of the patients is important for the family and caregivers of the patients 11,18,25–29 . Non‐pharmacological intervention, 12–14,30 a care program, 31 and support of the patients and family 19,32 will be even more important for the treatment of Alzheimer's disease patients.…”

Effect and tolerability of blonanserin in severe delusion with various types of dementia

“…BNS has been reported to be comparatively well tolerated in the treatment of schizophrenia . There has been only one report, covering five cases, that suggests that BNS is effective for the treatment of behavioural and psychological symptoms of Alzheimer's disease …”