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Management of Neuropsychiatric Symptoms in People with Dementia

  • Therapy in Practice
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Abstract

Neuropsychiatric symptoms are frequent and troublesome in people with dementia and present a major treatment challenge for clinicians. Most good practice guidelines suggest non-pharmacological treatments as the first-line therapy and there is emerging evidence, including randomized controlled trials, that a variety of psychological and training interventions, including social interaction and person-centred care training, are effective. There is evidence from meta-analyses that some atypical antipsychotic drugs, specifically risperidone and aripiprazole, confer benefit in the treatment of aggression in people with Alzheimer’s disease over a period of up to 12 weeks. However, these benefits have to be considered in the context of significant adverse events, including extrapyramidal symptoms, accelerated cognitive decline, stroke and death. In addition, the limited evidence available does not indicate ongoing treatment benefits over longer periods of therapy. The evidence is limited for other pharmacological treatment approaches, but the best evidence is probably for carbamazepine, memantine and citalopram. There is very limited evidence for any therapies in non-Alzheimer dementias.

In conclusion, it is important in most situations to limit the use of antipsychotic medication to short-term treatment (up to 12 weeks) of severe neuropsychiatric symptoms to limit harm. Non-pharmacological therapies offer a viable and effective alternative in many situations. Adequately powered randomized controlled trials for the treatment of clinically significant agitation are urgently needed to explore alternative pharmacological therapies.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The time spent on the review by Dr Ballard and Dr Corbett was supported by the Alzheimer’s Society. Within the last 5 years, Dr Ballard has acted as a consultant for or received honoraria from Novartis, Eisai, Shire, Lundbeck, Myriad, Arcadia and Servier pharmaceutical companies, and research grants from Lundbeck pharmaceutical company. Dr Corbett has no conflicts of interest that are directly relevant to the content of this review.

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  1. Wolfson Centre for Age-Related Diseases, Guy’s Campus, King’s College London, London, SE1 1UL, UK

    Clive Ballard & Anne Corbett

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Correspondence to Clive Ballard.

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Ballard, C., Corbett, A. Management of Neuropsychiatric Symptoms in People with Dementia. CNS Drugs 24, 729–739 (2010). https://doi.org/10.2165/11319240-000000000-00000

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