Antipsychotic Use for Symptoms of Dementia
Antipsychotic Use for Symptoms of Dementia
During the moderate and late stages of dementia, patients experience behavioral and psychological symptoms of dementia (BPSD), such as agitation, psychosis, and aggression. There is no FDA-approved treatment for BPSD, but antipsychotics are frequently prescribed off-label. Antipsychotics yield only modest improvements in BPSD and have been shown to increase death in elderly patients with dementia. It is recommended that, as a part of patient-centered care, nursing homes involve consultant pharmacists in the development and review of medication-safety procedures.
Dementia is a disorder characterized by cognitive and functional impairment. Alzheimer disease (AD), the most common form of chronic dementia, affected 4.7 million Americans in 2010. The number of patients with AD is expected to approach 13.8 million by 2050 and will cost the United States an estimated $1.1 trillion per year in drug and medical costs.
In the moderate to late stages of AD, patients have difficulty communicating, completing complex tasks, and remembering new information. Additionally, behavioral and psychological symptoms of dementia (BPSD), such as delusions, wandering, aggression, and agitation, occur in 60% to 90% of patients with dementia. These symptoms are associated with greater functional impairment and frequently lead to nursing home placement.
Currently, there is no FDA-approved treatment for BPSD. Antipsychotics have evidence of slight efficacy; however, reports of increased mortality, cerebrovascular events, and cardiovascular effects in elderly patients prompted the FDA to issue a black box warning for these agents.
Abstract and Introduction
Abstract
During the moderate and late stages of dementia, patients experience behavioral and psychological symptoms of dementia (BPSD), such as agitation, psychosis, and aggression. There is no FDA-approved treatment for BPSD, but antipsychotics are frequently prescribed off-label. Antipsychotics yield only modest improvements in BPSD and have been shown to increase death in elderly patients with dementia. It is recommended that, as a part of patient-centered care, nursing homes involve consultant pharmacists in the development and review of medication-safety procedures.
Introduction
Dementia is a disorder characterized by cognitive and functional impairment. Alzheimer disease (AD), the most common form of chronic dementia, affected 4.7 million Americans in 2010. The number of patients with AD is expected to approach 13.8 million by 2050 and will cost the United States an estimated $1.1 trillion per year in drug and medical costs.
In the moderate to late stages of AD, patients have difficulty communicating, completing complex tasks, and remembering new information. Additionally, behavioral and psychological symptoms of dementia (BPSD), such as delusions, wandering, aggression, and agitation, occur in 60% to 90% of patients with dementia. These symptoms are associated with greater functional impairment and frequently lead to nursing home placement.
Currently, there is no FDA-approved treatment for BPSD. Antipsychotics have evidence of slight efficacy; however, reports of increased mortality, cerebrovascular events, and cardiovascular effects in elderly patients prompted the FDA to issue a black box warning for these agents.
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