Antipsychotic Medications May Ease Some Alzheimer’s Symptoms, Not Others

Antipsychotic medications may lessen symptoms like hostility and aggression in patients with Alzheimer’s disease, but do not appear to lessen other symptoms or improve quality of life, according to a recent analysis of data from the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness Alzheimer’s Disease (CATIE-AD) study. The analysis was published online ahead of print June 2, 2008, in the American Journal of Psychiatry.

The 421 participants in the CATIE-AD study all had Alzheimer's-related dementia with additional symptoms such as delusions, aggression, hallucinations, or agitation that were severe enough to disrupt their functioning. Previously reported results of CATIE-AD concluded that the antipsychotic medications compared in the trial (olanzapine, quetiapine, and risperidone) were no more effective than placebo (sugar pill) when adverse effects were considered. This new analysis delved deeper to measure effects of the medications on patients.

David Sultzer, M.D., of the University of California Los Angeles, and colleagues found that CATIE-AD participants who completed the first 12 weeks of treatment with risperidone or olanzapine showed significant improvement in symptoms of hostility, aggression, mistrust and uncooperativeness, compared to placebo. However, none of the antipsychotic medications showed benefit in treating symptoms of depression, cognitive difficulties or functional disability. Further, those taking olanzapine showed increased symptoms of blunted emotions.

The researchers caution that these results show average group outcomes and may not apply to individual treatment effects. Doctors should consider each patient’s circumstances, vulnerabilities and needs to determine if potential benefits will outweigh potential adverse effects, say the researchers. Sultzer and colleagues conclude by calling for additional research to identify potential subgroups of patients with certain neurobiological factors or symptom characteristics that may predispose them to specific responses to antipsychotic treatments.

Reference

Sultzer DL, Davis SM, Tariot PN, Dagerman KS, Lebowitz BD, Lyketsos CG, Rosenheck RA, Hsaio JK, Lieberman JA, Schneider LS for the CATIE Study Group. Clinical symptom responses to atypical antipsychotic medications in Alzheimer’s Disease: Phase I outcomes from the CATIE-AD effectiveness trial. American Journal of Psychiatry. online ahead of print June 2, 2008.