Pharmacological management of behavioral symptoms associated with dementia

Abstract

Dementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer’s, frontotemporal, Parkinson’s, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administration-approved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used off-label. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations.

Keywords: Alzheimer’s disease, Dementia, Pharmacological management, Psychotropics, Antipsychotics

Core tip: Dementia may present with neuropsychiatric symptoms that may require pharmacological interventions. Medications used for the behavioral symptoms associated with dementia are not Food and Drug Administration-approved and hence are being used off-label in the United States. The decision to start medications is based on a judicious consideration of risks and benefits. The choice of the agent should be guided by a thorough understanding of its pharmacologic properties and safety profiles, concomitant medications, and concurrent medical conditions. This article reviews the current evidence for psychotropic medications and presents recommendations with an algorithm for the treatment of neuropsychiatric symptoms associated with dementia.