Dementia risperidone

Brodaty H, Ames D, Snowdon 1 et al. (2003) A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. 1 Clin Psychiatry 64(2) 134-143... 

De Deyn PP, Rabheru K, Rasmussen A et al. (1999) A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 53(5) 946-955... 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Risperidone and olanzapine have been widely used in patients with dementia exhibiting behavioural problems. Following the withdrawal of thioridazine from the market, old age psychiatrists and GPs were increasingly atypical antipsychotics, in particular risperidone as it was the only atypical which had been examined in randomised clinical trials (RCTs) with the elderly. In 2004, the advised that both risperidone... 

Cerebrovascuiar effects Gerebrovascular adverse reactions (eg, stroke, transient ischemic attack), including fatalities, were reported in patients (mean, 85 years of age range, 73 to 97 years of age) in trials of risperidone in elderly patients with dementia-related psychosis. 

Risperidone is a selective antagonist of both D2 and 5-HT2 receptors. It is currently the neuroleptic leader in the treatment of schizophrenia and of dementia. 

Atypical neuroleptics have a better side-effect profile, and several studies have confirmed their efficacy. Risperidone has been found effective in the treatment of dementia in patients with agitation (N. Hermann et al. 1998 Jeanblanc and Davis 1995 Jeste et al. 1996 I. R. Katz et al. 1999 Lavretsky and Sultzer 1998), in patients with Lewy body disease (Geizer and Ancill 1998), or in patients with L-dopa-induced hallucinations (Meco et al. 1994). Risperidone has better tolerability than classic neuroleptics such as thioridazine and haloperidol (Frenchman and Prince 1997). No studies of the efficacy of olanzapine in the treatment of agitation in patients with dementia have been done, but its use is widely advocated. 

Freeman TW, Clothier JL, Pazzaglia P, et al A double-blind comparison of valproate and lithium in the treatment of acute mania. Am J Psychiatry 149 108-111,1992 Frenchman IB, Prince T Clinical experience with risperidone, haloperidol, and thioridazine for dementia-associated behavioral disturbances. Int Psychogeriatr 9 431-435, 1997... 

Geizer M, Ancill RJ Combination of risperidone and donepezil in Lewy body dementia. Can J Psychiatry 43 421-422, 1998... 

Hermann N, Eryavec G Buspirone in the management of agitation and aggression associated with dementia. Am J Geriatr Psychiatry 1 249-253, 1993 Hermann N, Rivard ME, Flynn M, et al Risperidone for the treatment of behavioral disturbances in dementia a case series. J Neuropsychiatry Clin Neurosci 10 220-223, 1998... 

Jeanblanc W, Davis YB Risperidone for treating dementia associated aggression. Am J Psychiatry 152 1239, 1995... 

Katz IR, Jeste DV, Mintzer JE, et al Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia a randomized, double-blind trial Risperidone Study Group. J Clin Psychiatry 60 107-115, 1999... 

Lavretsky H, Sultzer D A structured trial of risperidone for the treatment of agitation in dementia. Am J Geriatr Psychiatry 6 127-135, 1998 Lawlor BA, Sunderland T, Mellow AM, et al Hyper responsivity to the serotonin agonist m-chlorophenylpiperazine in Alzheimer s disease a controlled study. Arch Gen Psychiatry 46 542-549, 1989a... 

Madhusoodanan S, Brenner R, Araujo L, et al. Efficacy of risperidone treatment for psychoses associated with schizophrenia, schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric patients a case series. J din Psychiatry 1995 56 514-518. 

Research indicates that typical and atypical neuroleptic drugs increase the vulnerability of neurons to cell death and even kill brain cells and that the risk increases in patients already suffering from brain disorders such as Alzheimer s (chapter 5). Consistent with this, Sechi et al. (2000) reported on a case of NMS following exposure of a patient with familial dementia with Lewy bodies to low doses of risperidone. 

Baker, B. (1996, September). Risperidone cuts symptoms of dementia in elderly. Clinical Psychiatry News, p. 19. 

Sechi, G., Agnetti, V., Masuri, R., Deiana, G., Pugliatti, M., Paulus, K., et al. (2000). Risperidone, neuroleptic malignant syndrome and probable dementia with Lewy bodies. Progress in Neuro-psychopharmacology and Biological Psychiatry, 24, 1043-1051. 

In the light of evidence from large, randomized, double-blind trials, the authors of a thorough review of the role of atypical neuroleptic drugs in the treatment of psychosis and agitation associated with dementia have concluded that low-dose risperidone (0.25-1.5 mg/day) can be used as first-line treatment (19). 

Layton D, Harris S, Wilton LV, Shakir SA. Comparison of incidence rates of cerebrovascular accidents and transient ischaemic attacks in observational cohort studies of patients prescribed risperidone, quetiapine or olanzapine in general practice in England including patients with dementia. J Psychopharmacol 2005 19 473-82. 

Fontaine CS, Hynan LS, Koch K, Martin-Cook K, Svetlik D, Weiner MF. A double-blind comparison of olanzapine versus risperidone in the acute treatment of dementia-related behavioral disturbances in extended care facilities. J Clin Psychiatry 2003 64 726-30. 

Several symptoms of dementia can be improved by risperidone. In 18 patients with Alzheimer s disease (no sex or age data reported), delusions of theft, hallucinations, and agitation/aggression improved significantly after 12 weeks of treatment (22). The modal optimal dosage was 1 mg/day, the same already suggested for this pathology (SEDA-26, 64). There were mild extrapyramidal symptoms at some point during the trial in one patient. 

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