Role of atypical antipsychotics in the treatment of psychosis and agitation associated with dementia

The drug treatment of elderly patients is challenging because of the various pharmacokinetic and pharmacodynamic changes associated with increasing age, and the frequent comorbid medical conditions found in and multiple concurrent medications used by this population. Behavioural symptoms, such as agitation and psychosis, commonly occur with dementia. Until recently, conventional antipsychotics were the mainstay of treatment, but their use in geriatric patients is limited because of serious adverse events. Compared with conventional antipsychotic agents, risperidone, olanzapine and quetiapine appear to be generally well tolerated in the elderly population (the use of clozapine is limited by its adverse effects). However, only 1 large controlled trial of one of these atypical antipsychotics (risperidone) in the treatment of behavioural symptoms of dementia has been published. While data indicate that risperidone may be the drug of choice, head-to-head, double-blind, controlled, comparative studies assessing the efficacy, tolerability and pharmacoeconomics of atypical antipsychotics in patients exhibiting behavioural symptoms associated with dementia are warranted to clarify the most appropriate choice of treatment.