agents for treatment of associated behavioral symptoms of Alzheimer's disease
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Introduction
Considerations:
- choose agents with low anticholinergic effects
- minimize use of agents not well tolerated by the elderly (long-acting benzodiazepines)
- pharmacokinetic considerations in the elderly
Agents for:
- depression
- use agent with low anticholinergic effect
- apathy
- methylphenidate may be of benefit
- may reduce symptoms & caregiver burden[3]
- does not affect patients' function or quality of life[3]
- methylphenidate may be of benefit
- anxiety: anxiolytics
- agitation (also see psychosis & agitation in the elderly)
- atypical antipsychotics (may be agents of choice)
- Haldol
- benzodiazepines (short acting)
- infrequent & PRN use if possible
- form of chemical restraint
- OBRA regulations require documentation of symptoms & attempts to gradually reduce dose
More specific terms
- haloperidol (Haldol, Halperon, Aloperidol, Halomonth)
- olanzapine (Zyprexa, Zydis, Zyprexa, Relprevv)
- quetiapine (Seroquel)
- risperidone (Risperdal)
- trazodone (Desyrel, Pragmazone, Oleptro)
Additional terms
- depression in the elderly
- pharmacokinetics in the elderly
- psychosis, agitation & difficult behavior in the elderly
References
- ↑ Prescriber's Letter 8(7):40 2001 Doody RS et al, Practice Parameter: management of dementia (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology, Neurology 56:1154-1156, 2001 (Guideline withdrawn 02/2009) PMID: https://www.ncbi.nlm.nih.gov/pubmed/11342679
- ↑ Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005 Dec 1;353(22):2335-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319382
Ray WA. Observational studies of drugs and mortality. N Engl J Med. 2005 Dec 1;353(22):2319-21. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319379 - ↑ 3.0 3.1 3.2 Mintzer J, Lanctot KL, Scherer RW et al Effect of Methylphenidate on Apathy in Patients With Alzheimer Disease. The ADMET 2 Randomized Clinical Trial. JAMA Neurol. Published online September 27, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34570180 https://jamanetwork.com/journals/jamaneurology/fullarticle/2784538
Fredericks C Methylphenidate for Apathy in Alzheimer Disease - Why Should We Care? JAMA Neurol. Published online September 27, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34570178 https://jamanetwork.com/journals/jamaneurology/fullarticle/2784541