No magic pill for treating dementia symptoms

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.