Understanding of Antipsychotics in Elderly Patients with Dementia

Abstract

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.

Incidence of hospital contacts with acute kidney injury after initiation of second-generation antipsychotics in older adults: a Danish population-based cohort study

“…Most SGAs are antagonists of the dopamine D2-receptor, interacting with the sympathetic nervous system to regulate blood pressure [38]. Each of the SGAs' selective dopamine receptor occupancy rate is different, and possibly dosedependent [39]. Based on available information, olanzapine has the strongest affinity to the D4 and D1 receptors, thus interacting mostly with the renin-angiotensin-aldosterone system (RAAS) [38].…”

Anxiety in Dementia

“…Quetiapine has been effective as an add on to selective serotonin reuptake inhibitos or venlafaxine in a study of anxiety comorbid with depression in 58 adults 54. However, careful application should be needed in extrapolating these findings to the management of anxiety in dementia, because of the risk of adverse effects (including sedation and cerebrovascular events) in older people 55…”

“… 54 However, careful application should be needed in extrapolating these findings to the management of anxiety in dementia, because of the risk of adverse effects (including sedation and cerebrovascular events) in older people. 55 …”