Most people with dementia or Alzheimer's disease will, at some point in their illness, show signs of aggression, agitation or psychosis. When these symptoms are so severe that individuals present a serious risk to themselves or to others, a class of drugs known as antipsychotics (or neuroleptics) are often used.
However, several recent studies have found that antipsychotics are associated with an increased risk of death when used in older people with dementia and Alzheimer's disease. In fact, the U.S. Food and Drug Administration (FDA) now mandates that drug makers add what is referred to as a "black box" warning to the labels of all antipsychotics, alerting doctors and patients to this increased mortality risk in people with dementia-related psychosis.
Since those warnings were first implemented in 2005, the use of antipsychotics for older people with dementia has declined significantly. Nonetheless, almost 10 percent of antipsychotic use is still attributed to people with dementia. In addition, about one third of nursing home residents with dementia receive antipsychotics.
Typical and Atypical Antipsychotics. Antipsychotic drugs were first developed in the 1950s to treat schizophrenia.
However, several recent studies have found that antipsychotics are associated with an increased risk of death when used in older people with dementia and Alzheimer's disease. In fact, the U.S. Food and Drug Administration (FDA) now mandates that drug makers add what is referred to as a "black box" warning to the labels of all antipsychotics, alerting doctors and patients to this increased mortality risk in people with dementia-related psychosis.
Since those warnings were first implemented in 2005, the use of antipsychotics for older people with dementia has declined significantly. Nonetheless, almost 10 percent of antipsychotic use is still attributed to people with dementia. In addition, about one third of nursing home residents with dementia receive antipsychotics.
Typical and Atypical Antipsychotics. Antipsychotic drugs were first developed in the 1950s to treat schizophrenia.
- The first generation of these drugs is sometimes referred to as "typical" or "conventional" antipsychotics; they include chlorpromazine and haloperidol (Haldol). Typical antipsychotics work by blocking the receptors for the neurotransmitter dopamine and can cause a number of side effects that affect physical movement, such as tremors, rigidity, restlessness and muscle spasms.
- In the 1990s, a second generation of antipsychotics known as atypical was introduced. These also block dopamine receptors but have fewer of the movement-related side effects that plagued users of the older, typical antipsychotics. Still, atypical antipsychotics have potentially serious side effects, including drowsiness, dizziness, blurred vision, rapid heartbeat, sexual dysfunction and skin rashes. They can also cause significant weight gain, and if left unchecked, people taking them may risk developing diabetes or high cholesterol levels. Examples of atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel).
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