The pharmacological treatment of behavioral and psychological symptoms of Alzheimer's disease

The prevalence of Alzheimer's disease is increasing rapidly and it is becoming a scourge of our times. Behavioral and psychological symptoms are a common aspect of the spectrum of the disease symptoms and are associated with poor prognosis. Their treatment constitutes a challenge because of its importance for the quality of life of the patients and their caregivers, and it warrants appropriate action. Non-pharmacological interventions should be the first step in the management of these symptoms, but when their effect is insufficient, a wide variety of pharmacological agents can contribute to the amelioration of behavioral and psychological symptoms. The objective of this study was to evaluate the efficacy of various different classes of pharmacological agents in the management of the neuropsychiatric symptoms of Alzheimer's disease. A systematic review of articles, concerning studies which examined the effectiveness of drug therapies in the treatment of behavioral and psychological symptoms was conducted, using MEDLINE and Pubed. Antidepressants proved to be effective only in the treatment of depression and not for other neuropsychiatric symptoms. Cholinesterase inhibitors generally appeared to have small, though statistically significant efficacy. The efficacy of typical neuroleptics was limited and adverse effects were common. The results of studies on the efficiency of atypical antipsychotics showed a modest, statistically significant efficacy with minimal adverse effects at lower dosages. Atypical antipsychotics were associated with an increased risk of death. Newer retrospective cohort studies however suggest that conventional antipsychotics are at least as likely as atypical agents to increase the risk of mortality. The results of the studies of memantine and carbamazepine are conflicting, and valproate is not effective in the treatment of neuropsychiatric symptoms.