Psychotropic medication use for behavioral symptoms of dementia

@article{Wang2006PsychotropicMU,
  title={Psychotropic medication use for behavioral symptoms of dementia},
  author={Philip S. Wang and M. Alan Brookhart and Soko Setoguchi and Amanda R. Patrick and Sebastian Schneeweiss},
  journal={Current Neurology and Neuroscience Reports},
  year={2006},
  volume={6},
  pages={490-495}
}
Behavioral disturbances associated with dementia are common and burdensome. Although no psychotropic medications are currently approved by the US Food and Drug Administration (FDA) to treat such behavioral symptoms, a variety of drug classes are commonly used for these purposes. Atypical antipsychotic medications may be somewhat effective and are generally considered the pharmacologic treatments of choice; however “black box” warnings have recently been added to their labels by the FDA, warning… 
Medical Management of Frontotemporal Dementias: The Importance of the Caregiver in Symptom Assessment and Guidance of Treatment Strategies
  • G. Jicha
  • Biology, Medicine
    Journal of Molecular Neuroscience
  • 2011
TLDR
The importance of establishing an effective therapeutic partnership between the physician and caregiver in the medical management of the person suffering from FTD is highlighted.
Roles for pharmacists in improving the quality use of psychotropic medicines in residential aged care facilities
TLDR
The key objective of this thesis was to assess if pharmacists could positively influence RACF psychotropic utilisation through the use of a series of facility-focused QUM strategies delivered in a dedicated intervention project.
Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes
TLDR
Among older patients admitted to nursing homes, the risks of death and femur fracture associated with conventional antipsychotic, antidepressants and benzodiazepines are comparable to or greater than the risks associated with atypical antipsychotics.
Assessing Residual Confounding of the Association between Antipsychotic Medications and Risk of Death using Survey Data
TLDR
Claims data studies tend to underestimate the association of typical antipsychotic use and death compared with atypical antipsychotics because of residual confounding by measures of frailty.
Psychopharmacological Neuroprotection in Neurodegenerative Disease: Heuristic Clinical Applications
TLDR
A broad array of neuroprotective mechanisms are considered and, based on evidence reviewed, agents with pharmacodynamic mechanisms of action that may be associated with neuroprotection are considered.
Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study
TLDR
The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine, reinforcing the concept that they should be used in the absence of clear need.
Association of antipsychotic use with hospital events and mortality among medicare beneficiaries residing in long-term care facilities.
TLDR
This study provides no evidence of increased hospital events or mortality in LTC residents who use AP medications, and contribute to a growing body of evidence that APs, particularly atypical agents, may be associated with reduced mortality inLTC residents.
Comparative Safety of Antipsychotic Medications in Nursing Home Residents
TLDR
To compare the risk of major medical events in nursing home residents newly initiated on conventional or atypical antipsychotic medications (APMs), a comparison of six trials over a 12-month period shows clear trends in survival and morbidity.
...
...

References

SHOWING 1-10 OF 54 REFERENCES
Trazodone for agitation in dementia.
TLDR
There is insufficient evidence to recommend the use of trazodone as a treatment for behavioural and psychological manifestations of dementia, and longer-term trials are needed, involving larger samples of participants with a wider variety of types and severities of dementia.
Behavioral and psychological symptoms in dementia: the role of atypical antipsychotics.
  • B. Lawlor
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2004
TLDR
Initial intervention in dementia patients exhibiting BPSD should focus on nonpharmacologic measures, and the quality of patient care should be optimized with potential physical, environmental, social, and psychiatric triggers being addressed where possible.
Atypical Antipsychotics in Older Adults
TLDR
Several psychiatric and medical conditions that are associated with psychotic symptoms in older people are reviewed, as well as how these patients may benefit from treatment with these agents.
The efficacy, safety, and tolerability of antipsychotics in the elderly.
TLDR
The atypical antipsychotics with their lower propensity to cause EPS and lower need for augmenting anticholinergic medication have introduced new options for elderly patients who need antipsychotic therapy for a number of psychiatric and neurologic disorders with psychotic manifestations.
Pharmacological Treatment of Psychosis and Agitation in Elderly Patients with Dementia
TLDR
Conventional antipsychotic medication is modestly effective for treatment of psychosis and agitation in elderly individuals with dementia, whereas newer treatments such as atypical antipsychotics appear to be at least as effective while having fewer adverse effects.
Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials.
TLDR
Atypical antipsychotic drugs may be associated with a small increased risk for death compared with placebo, and this risk should be considered within the context of medical need for the drugs, efficacy evidence, medical comorbidity, and the efficacy and safety of alternatives.
Risk of death in elderly users of conventional vs. atypical antipsychotic medications.
TLDR
Conventional antipsychotic medications are at least as likely as atypical agents to increase the risk of death among elderly persons and that conventional drugs should not be used to replace atypicals agents discontinued in response to the FDA warning.
Atypical antipsychotics for aggression and psychosis in Alzheimer's disease
TLDR
Evidence suggests that risperidone and olanzapine are useful in reducing aggression and ris peridone reduces psychosis, but both are associated with serious adverse cerebrovascular events and extrapyramidal symptoms.
Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence.
TLDR
Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy, however, the effects are modest and further complicated by an increased risk of stroke.
Behavioral and Neuropsychiatric Outcomes in Alzheimer's Disease
TLDR
For patients with severe behavioral and psychological symptoms of dementia, pychotropic agents may be warranted, whereas approved therapies for Alzheimer's, including cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine, may be appropriate in less severe cases.
...
...