Treating behavioural and psychological signs in Alzheimer's disease

The evidence for current pharmacological treatments is not strong

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 use of these agents in patients with dementia.4

In 1990 Schneider published a landmark study showing the paucity of large, placebo controlled, double …