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 and inconsistent benefits, while posing risks, including over sedation, cognitive worsening, and increased likelihood of falls, strokes, and mortality. Use of these drugs in patients with dementia should be limited to cases where non-pharmacologic 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
• Neurologic
• Psychiatric and Psychologic

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.
• Gitlin LN, Kales HC, Lyketsos, CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA. 2012 Nov 21;308(19):2020-9.