BPSD （behavioral and psychological symptoms of dementia） are common remediable cause
of excess morbidity and lead to significant impairment in quality of life for both
patients and their caregivers, as well as an increased risk of institutionalization.
The most common treatment of BPSD is neuroleptic medication. Compared to other agents,
conventional neuroleptics have been studied with relatively rigorous
placebo-controlled trials. Efficacy is modest, but concerns regarding side effects,
such as extrapyramidal symptoms, tardive dyskinesia, and emotional withdrawal, have
often limited their uses. Treatment of BPSD with atypical antipsychotics such as
risperidone or olanzapine is potentially advantageous in view of their tendency to
cause considerably fewer side effects. But elderly demented patients may be
particularly sensitive to untoward side effects of psychotropic drugs. The different
atypical antipsychotics do have their own side effects and other limitations.
Clinicians who prescribe antipsychotics for BPSD should start with a low initial dose,
increasing this dose slowly until the lowest effective dose is reached. It is
important to remember that although antipsychotics provide symptomatic relief, they do
not cure underlying dementia. Clinicians should try to avoid prescribing multiple
drugs with anticholinergic or sedative effects. Further study to determine more
specific drug-responsive symptoms is needed to maximize benefits of atypical
antipsychotics.
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