Olanzapine as a possible treatment of behavioral symptoms in vascular dementia: risks of cerebrovascular events

Abstract

Behavioral problems produce excess disability, potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisia. We followed up (for 12 months) a group of 346 consecutive outpatients, with a diagnosis of subcortical vascular dementia or multi-infarctual dementia. Patients eligible for this open-label study were required to have behavioral problems (BPSD). Patients were divided into two groups, Group A received olanzapine 2.5-7.5 mg/day while Group B received typical antipsychotics. Patients in both groups were allowed to continue any previous therapy. Patients in both groups were significantly improved in their BPSD. Our patients had a host of medical conditions and received numerous concomitant medications. Given the potential complications associated with these therapeutic agents, these patients tolerated olanzapine quite well. On examination of consequences of adverse events, particularly somnolence, postural instability, and postural hypotension, it appeared that cerebrovascular events were not present. Moreover, no anticholinergic effect was recorded. These findings suggest that olanzapine could be a safe and effective treatment even for elderly population in suitable doses and receiving the adequate follow-up.

Response to guidance on use of olanzapine and risperidone: a community-based study of primary and secondary care

“…However, a third large populationbased retrospective study found an increased risk of cerebrovascular accidents with risperidone (but not with other atypicals) compared with traditional antipsychotics (Percudani et al, 2005). Other studies have found no increased risk of cerebrovascular events with atypical antipsychotics (Finkel et al, 2005;Liperoti et al, 2005;Moretti et al, 2005;Suh & Shah, 2005).…”

Ethical dilemma associated with the off‐label use of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia

“…Preliminary analysis suggested that olanzapine (5 or 10 mg/day) reduces psychosis in patients with DLB without worsening parkinsonism. 18 Moretti et al 19 performed a controlled open-label study investigating the treatment of behavioral symptoms in vascular dementia. They followed (for 12 months) a group of 346 consecutive outpatients with a diagnosis of subcortical vascular dementia or multi-infarctual dementia.…”

“…They followed (for 12 months) a group of 346 consecutive outpatients with a diagnosis of subcortical vascular dementia or multi-infarctual dementia. Moretti et al 19 found that patients receiving olanzapine (2.5-7.5 mg/day) showed significantly improved BPSD. In addition, the patients were receiving numerous medications for the treatment of concomitant medical conditions.…”

“…Given the potential complications associated with these medications, these patients tolerated olanzapine quite well. Moretti et al 19 concluded that olanzapine could be a safe and effective treatment for BPSD due to vascular dementia when given in suitable doses and adequately followed up.…”

Psychiatric and behavioral symptoms in Alzheimer’s disease and other dementias: Etiology and management

“…In fact, several other reports question the notion that atypical antipsychotics increase the risk for stroke [52][53][54]. The US Food and Drug Administration recently issued a public health advisory to warn against an increased risk of mortality in patients with dementia-related behavioral disorders in using all types of atypical antipsychotics, which might be linked to the risk of these drugs inducing hypotension, tachycardia, hemoconcentration, or other factors [50].…”