BMJ 1999;319:138-139 ( 17 July )

Editorials

Treating behavioural and psychological signs in Alzheimer's disease

The evidence for current pharmacological treatments is not strong

The first 150 words of the full text of this article appear below.

Dementia is a prominent healthcare issue for primary care physicians and specialist services. Over 90% of patients with dementia experience a "behaviour disturbance,"¹ often referred to as behavioural or psychological signs in dementia in accordance with the recommendation of the International Psychogeriatric Association. These symptoms are distressing to patients and troublesome to carers and often precipitate admission to residential facilities.¹ What is the evidence that any of the several drugs that are currently used to treat these symptoms are effective?

Managing the behavioural and psychological signs of dementia is a major problem for healthcare professionals. Neuroleptic drugs are the mainstay of pharmacological treatment, although their use is justified largely on the basis of clinical anecdote, and they have many harmful side effects. These include parkinsonism, drowsiness, tardive dyskinesia, falls, accelerated cognitive decline,² and severe neuroleptic sensitivity reactions.³ It is therefore not surprising that the chief medical officer has recommended judicious . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial

Clive Ballard, Marisa Margallo-Lana, Edmund Juszczak, Simon Douglas, Alan Swann, Alan Thomas, John O'Brien, Anna Everratt, Stuart Sadler, Clare Maddison, Lesley Lee, Carol Bannister, Ruth Elvish, and Robin Jacoby
BMJ 2005 330: 874. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Chan, D.-C., Kasper, J. D., Black, B. S., Rabins, P. V. (2007). Clinical Diagnosis of Dementia, Not Behavioral and Psychologic Symptoms, Is Associated With Psychotropic Drug Use in Community-Dwelling Elders Classified as Having Dementia. J Geriatr Psychiatry Neurol 20: 100-106 [Abstract]  
• Chan, D.-C., Kasper, J. D., Black, B. S., Rabins, P. V. (2007). Clinical Diagnosis of Dementia, Not Presence of Behavioral and Psychological Symptoms, Is Associated With Psychotropic Use in Community-Dwelling Elders Classified as Having Dementia. J Geriatr Psychiatry Neurol 20: 50-57 [Abstract]  
• Schnelle, J. F., Osterweil, D., Simmons, S. F. (2005). Improving the Quality of Nursing Home Care and Medical-Record Accuracy With Direct Observational Technologies. Gerontologist 45: 576-582 [Abstract] [Full text]  
• Ballard, C., Margallo-Lana, M., Juszczak, E., Douglas, S., Swann, A., Thomas, A., O'Brien, J., Everratt, A., Sadler, S., Maddison, C., Lee, L., Bannister, C., Elvish, R., Jacoby, R. (2005). Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. BMJ 330: 874- [Abstract] [Full text]  
• Featherstone, K., James, I. A., Powell, I., Milne, D., Maddison, C. (2004). A Controlled Evaluation of a Training Course for Staff Who Work with People with Dementia. Dementia 3: 181-194 [Abstract]  
• Douglas, S., James, I., Ballard, C. (2004). Non-pharmacological interventions in dementia. Adv. Psychiatr. Treat. 10: 171-177 [Abstract] [Full text]  
• Buettner, L. L., Fitzsimmons, S. (2003). Activity calendars for older adults with dementia: What you see is not what you get. AM J ALZHEIMERS DIS OTHER DEMEN 18: 215-226 [Abstract]  
• Heller, T., Heller, L. (2003). First among Equals?: Does drug treatment for dementia claim more than its fair share of resources?. Dementia 2: 7-19 [Abstract]  
• Burns, A., Byrne, J., Ballard, C., Holmes, C. (2002). Sensory stimulation in dementia. BMJ 325: 1312-1313 [Full text]  
• Wooltorton, E. (2002). Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. CMAJ 167: 1269-1270 [Full text]  
• Cody, M., Beck, C., Svarstad, B. L. (2002). Mental Health Services in Nursing Homes: Challenges to the Use of Nonpharmacologic Interventions in Nursing Homes. Psychiatr. Serv. 53: 1402-1406 [Abstract] [Full text]  
• Treloar, A., Beck, S., Paton, C. (2001). Administering medicines to patients with dementia and other organic cognitive syndromes. Adv. Psychiatr. Treat. 7: 444-450 [Full text]  

Rapid Responses:

Read all Rapid Responses

Should acetylcholinesterase inhibitors be tried before neuroleptics?

Tomasz Sobow
bmj.com, 17 Jul 1999 [Full text]

Other important issues need to be addressed in further clinical trials

Ajit Shah
bmj.com, 19 Jul 1999 [Full text]

Strong agreement with the need for double blind trials.

Richard Gray
bmj.com, 16 Aug 1999 [Full text]

Online poll

Find out more here>> and here>>