Psychiatric and behavioral symptoms associated with Alzheimer's disease-such as anger, agitation, aggression, and paranoid thoughts and ideas-may improve with the use of second-generation antipsychotic medications, a new federally funded study has found. Improvements were seen both in global measures and in measures of specific symptoms. In addition, the analysis indicates that particular symptoms may respond better to different second-generation antipsychotic medications.
David L. Sultzer, M.D., and his colleagues in the CATIE-AD Study Group, followed 421 outpatients with Alzheimer's disease with associated symptoms of psychosis or agitation/aggression. Patients were randomly assigned to masked treatment with one of three second-generation antipsychotic medications (olanzapine, quetiapine, risperidone) or placebo, for up to 36 weeks. The primary CATIE-AD results found that there were no significant differences overall among medications with regard to the time to discontinuation of the medication. In the current analysis of patient symptoms at the end of phase one treatment, improvements were seen in both global and specific symptoms. Beneficial effects of olanzapine and risperidone were apparent in patients' total scores on the Neuro-psychiatric Inventory, which measures 12 psychiatric symptoms. Risperidone also showed a significant effect as measured with the Clinician's Assessment of Overall Change.
The improved symptom ratings, however, frequently occurred very close to the time when the clinician was changing the medication, often due to his or her assessment of insufficient efficacy. The authors note that clinicians may have been seeking even greater improvement, or were balancing benefit with other considerations, such as adverse effects or intolerance. Clinicians' treatment expectations and patients' circumstances probably contributed to the perception of effectiveness.
"The CATIE results indicate that hostility, aggression, and paranoia may improve with antipsychotic treatment, " said lead author David Sultzer, M.D., a professor of psychiatry and biobehavioral sciences at the UCLA School of Medicine, and director of the Gero/Neuropsychiatry Division for the VA Greater Los Angeles Healthcare System. "Although the benefits are modest on average, they don't seem to improve function, and we also need to consider possible side effects. Some 'agitated' symptoms may respond better than others, and this kind of information can help clinicians choose among treatment options. The best choices are based on individual patient's circumstances."
"Families and patients with Alzheimer's disease are severely affected by the hostility, agitation, and paranoia that often accompany the illness's signature memory loss," noted AJP editor-in-chief Robert Freedman, M.D. "It is clear that antipsychotic medications have helpful yet modest effects for some of these troubling behaviors. But this study also outlines the significant negative effects associated with treatment. We are publishing this study to give doctors new information for their patients about both the possible upside and downside of treatment with these medications."
The authors note that the average improvement on the rating scales was limited and was not apparent for all symptoms. Anger, aggression, and paranoid ideas showed the greatest improvement, as reflected by a more than 50 percent decrease in scores on the "hostile suspiciousness" factor of the BPRS among patients who completed 12 weeks of treatment with risperidone. Antipsychotic medications did not improve cognition, functional skills, caregivers' needs, or quality of life. In addition, patients taking olanzapine experienced a greater decline in functional skills, compared with those who took placebo. ...http://www.medicalnewstoday.com
posted by Valery Yermalitsky at
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