Newswise — Many of the drugs commonly
prescribed to treat agitation, delusions and other symptoms that can
accompany dementia are not effective, researchers from Wake Forest
University Baptist Medical Center and colleagues report this week in
the Journal of the American Medical Association.
“Our review of 29 research studies found
that drug therapies are not particularly effective for managing
symptoms such as agitation, wandering and delusions that are
observed in most patients with dementia at some point in the
illness,” said Kaycee Sink, M.D., lead researcher. “There is no
clear standard of care, and treatment is often based on local
prescribing customs.”
While the primary symptoms of
Alzheimer’s disease and other forms of dementia involve memory
deficits, other symptoms, including agitation, aggression,
delusions, hallucinations, repetitive vocalizations and wandering
have been observed in 60 percent to 98 percent of patients.
“Dementia-related behaviors are very
distressing to both caregivers and medical professionals,” said
Sink, a geriatrician. “It was discouraging to find that we currently
don’t have good drug therapies for them.”
More than half of people over age 85 are
affected by dementia. Dementia-related behavioral problems are
associated with longer hospital stays and often lead to placement in
a nursing home. About 30 percent of the cost of caring for patients
with Alzheimer’s disease is attributed to managing these symptoms,
Sink said.
Sink and colleagues, Karen F. Holden,
M.D., and Kristine Yaffe, M.D., both from the University of
California at San Francisco, reviewed 29 research studies published
between 1966 and mid-2004 that involved drug therapy commonly used
for patients with dementia-related behaviors.
The study was designed to evaluate the
effectiveness of current treatments for these behaviors and provide
physicians with an evidence-based assessment of treatment options.
The researchers analyzed data from studies evaluating more than 15
drugs that are commonly prescribed for dementia symptoms, including
antipsychotics, antidepressants and mood stabilizers. They found
that two drugs (risperidone and olanzapine) in a class known as
atypical antipsychotics have the best evidence for effectiveness.
“However, the effects are modest and are
complicated by an increased risk of stroke,” the authors write.
“Physicians considering prescribing these drugs should discuss the
potential risks and benefits with patients and their caregivers.”
Because federal expenditures for
dementia are expected to triple in the next 10 years, the authors
said it is essential to find more effective treatments.
They said non-drug therapies should always be considered first, and
that some small studies have shown that music therapy, aromatherapy,
pet therapy and caregiver education may be effective.
“Larger, well-designed controlled trials
of non-drug interventions are needed,” said Sink, an assistant
professor of internal medicine – geriatrics.
The authors said that additional studies of drug therapy are also
needed and that a large multi-center center study now under way to
compare four atypical antipsychotic drugs will be particularly
valuable.
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