Behavioral and Psychological Symptoms in Dementia (BPSD) and the Use of Antipsychotics

Valeria Calsolaro, Grazia Daniela Femminella, Sara Rogani, Salvatore Esposito, Riccardo Franchi, Chukwuma Okoye, Giuseppe Rengo, Fabio Monzani

Research output: Contribution to journalReview articlepeer-review

Abstract

Dementia affects about 47 million people worldwide, number expected to exponentially increase within 30 years. Alzheimer's disease (AD) is the most common dementia type, accounting on its own for almost 70% of all dementia cases. Behavioral and psychological symptoms (BPSD) frequently occur during the disease progression; to treat agitation, aggressiveness, delusions and hallucinations, the use of antipsychotic drugs should be limited, due to their safety issues. In this literature review regarding the use of antipsychotics for treating BPSD in dementia, the advantages and limitation of antipsychotic drugs have been evaluated. The available medications for the management of behavioral and psychological symptoms are the antipsychotics, classed into typical and atypical, depending on their action on dopamine and serotonin receptors. First generation, or typical, antipsychotics exhibit lack of tolerability and display a broad range of side effects such as sedation, anticholinergic effects and extrapyramidal symptoms. Atypical, or second generation, antipsychotics bind more selectively to dopamine receptors and simultaneously block serotonin receptors, resulting in higher tolerability. High attention should be paid to the management of therapy interruption or switch between antipsychotics, to limit the possible rebound effect. Several switching strategies may be adopted, and clinicians should "tailor" therapies, accounting for patients' symptoms, comorbidities, polytherapies and frailty.

Original languageEnglish
Article number246
Number of pages13
JournalPharmaceuticals
Volume14
Issue number3
DOIs
Publication statusPublished - Mar 9 2021

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