Choosing Wisely:

Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.

Rationale and Comments: People with dementia often exhibit aggression, resistance to care, and other challenging or disruptive behaviors. In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including stroke and premature death. Use of these drugs should be limited to cases where nonpharmacologic measures have failed and patients pose an imminent threat to themselves or others. Identifying and addressing causes of behavior change can make drug treatment unnecessary.
Sponsoring Organizations:
  • American Geriatrics Society
  • Sources:
  • American Geriatrics Society guidelines
  • National Institute for Health and Clinical Excellence guidelines
  • Disciplines:
  • Geriatric Medicine
  • Psychiatric and Psychologic
  • Neurologic
  • References: • American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616-31.
    • National Institute for Health and Clinical Excellence and Social Care Institute for Excellence. NICE-SCIE clinical guidelines #42. http://www.nice.org.uk/CG042.
    • Maher AR, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011;306(12): 159-60.
    • Schnieder LS, et al. Effectiveness of atypical antipsychotics in patients with Alzheimer’s disease. N Engl J Med. 2006;355 (15):1525-38.

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