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The pharmacological management of neuropsychiatric
symptoms of dementia remains a significant challenge for clinicians.
Herrmann and Lanctôt provide a comprehensive review of
the available medications highlighting the modest efficacy of
many agents and concerns about potentially serious adverse events.
While it was hoped that the cholinesterase inhibitors could
provide significant benefit for AD patients with moderately
severe agitation, a recent RCT with donepezil was negative (Howard
et al ). Unfortunately, more data has emerged about the
safety of the antipsychotics including their potential to increase
the risk of hip fractures (Liperoti et al ) and mortality
(Kales et al ). The one bright spot in this therapeutic
arena may be citalopram. In an RCT with risperidone, citalopram
was found to be equally efficacious, with fewer side effects
(Pollock et al ).
Pharmacologic management of neuropsychiatric
symptoms of Alzheimer disease
(Can J Psychiatry 2007;52:630–646)
N. Herrman, MD, FRCPC,
K. L Lanctôt, PhD
Toronto, ON
Donepezil for the treatment of agitation
in Alzheimer’s disease
(NEJM 2007; 357[14]:1382-1392)
R.J. Howard, MRC Psych,
E. Juszczak, BSc,
C.G. Balard, MRC Psych,
P. Bentharn, MRC Psych,
et al
for the CALM-AD
Trial Group
Various centres, UK
Conventional or atypical antipsychotics
and the risk of femur fracture among elderly patients: results
of a case-control study
(J Clin Psychiatry 2007;68:929-934)
Rosa Liperoti, MD, MPH;
Graziano Onder, MD, PhD,
Kate L. Lapane, PhD,
Vincent Mor, PhD,
et al
Rome, Italy
Providence, RI
Warwick, RI
Mortality risk in patients with dementia
treated with antipsychotics versus other psychiatric medications
(J Clin Psychiatry 2007;164:1568-1576)
Helen C. Kales, MD,
Marcia Valenstein , MD, MS,
H. Myra Kim, ScD,
John F. McCarthy, PhD,
et al,
Ann Arbor, MI
A double-blind comparison of citalopram
and risperidone for the treatment of behavioral and psychotic
symptoms associated with dementia
(Am J Geriatr Psychiatry 2007;15:1-1)
B. G. Pollock, MD, PhD,
Benoit H. Mulsant, MD,
Jules Rosen, MD,
Sati Mazumdar , PhD
et al
Toronto, ON,
Pittsburgh, PA
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