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Although cognitive disturbances such as memory and language impairment are the most recognized symptoms of dementia, the neuropsychiatric symptoms of dementia (NPSD) are often more concerning and can cause considerable disability and caregiver distress. The total annual cost of treatment for a patient with Alzheimer's disease (AD) who is living at home is estimated at $14,500. The direct management of behavioral and psychological symptoms accounts for 30% of this total. The last drug approval by the FDA for treatment of AD occurred approximately 15 years ago. Currently, no drug is FDA approved to treat NPSD, and no drugs for this indication are on the horizon. One second generation antipsychotic, risperidone, is approved in the United Kingdom and Australia for treating aggressive/assaultive behavior due to AD that poses harm to caregivers or the patient.
Nondrug approaches to managing NPSD, while recommended, are of questionable clinical value in reducing agitation or aggression in nursing home and assisted living facility residents with dementia. A variety of drugs are prescribed (off label) every day for behavioral symptoms related to dementia, despite the lack of FDA-approval. Many distinct types of drugs have been routinely used and/or studied to treat NPSD, including acetylcholinesterase inhibitors, antiepileptics, benzodiazepines, antipsychotics, antidepressants, and most recently, a combination of dextromethorphan and quinidine. None have emerged as clearly effective, resulting in many instances where a combination of medications is prescribed.This issue will review medications commonly prescribed for the management of dementia-associated neuropsychiatric symptoms, and discuss the pros andcons of selected agents. It is intended to serve as a guide to the safe, appropriate use of medications to manage troublesome behaviors related to AD, vascular dementia, dementia of the Lewy body type, and frontotemporal lobe dementia – the most prevalent types of dementia in the US and Europe.
This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.
Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.
The Rx Consultant is a publication of Continuing Education Network, Inc.
ACPE Universal Activity Number: 0428-0000-16-007-H01-P
Chief Editor and CE Administrator
Terry M. Baker, PharmD
Tracy Farnen, PharmD
James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Associate Clinical Professor
Richard Ron Finley, B.S. Pharm.,R.Ph.
Consult Pharmacist Aging and Adult Health Services
Julio R. Lopez, PharmD, FCSHP
Adjunct Clinical Professor
Assistant Clinical Professor
Visiting Associate Professor and Lecturer
Pamela Mausner, MD
Helen Berlie, Pharm.D. CDE, BCACP
Ambulatory Care Specialist - Diabetes
Senior Editorial Advisor
Gerard Hatheway, PharmD, PhD
Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD
Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners
Meuleman, RN, C, MS
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