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Novel Approaches to Understanding the Mechanisms of the Neuropsychiatric Symptoms in Alzheimer’s and Advancing Therapy Development


Jovier Evans, Ph.D.
Division of Translational Research


The goal of this initiative is to encourage research that will enhance knowledge of mechanisms underlying neuropsychiatric symptoms (NPS) in dementia so as to develop novel treatments.


In 2005, the FDA issued a black box warning for the use of antipsychotic medications in the elderly. Despite this warning, the use of antipsychotics among older adults has continued to rise, and most of the prescriptions for these medications are for off-label use. Recent work supported by NIMH documented that this includes increases in the percentage of older adults with dementia who are given atypical antipsychotic medications, most of them due to the behavioral and neuropsychiatric complications seen in dementia1. Recent GAO reports note that HHS needs to look beyond nursing homes and expand its initiatives aimed at curbing the use of these medications into other community settings.

The widespread use of antipsychotics points to the need to develop new and better treatments for behavioral and neuropsychiatric symptoms (NPS) seen in dementia. The demand for novel treatment approaches highlights the importance of identifying and dealing with the underlying causes of these symptoms among older adults with dementia. There is thus an urgent need to advance the mechanistic understanding of these problems to identify new treatment targets. The National Plan to Address Alzheimer’s Disease  specifically calls for the development of better treatments for the behavioral and psychiatric complications due to the disease and the NIMH is specifically responsible for supporting research in this area.

Expected Outcomes of this initiative include:

  • Stronger, mechanistic work in the field of NPS associated with dementia
  • Improved understanding of neurobiological and behavioral mechanisms underlying NPS
  • Preliminary data in the translational space for further treatment development
  • Build this area of research within the NIMH portfolio


1 Olfson, M., King, M., Schoenbaum, M. (2015) Antipsychotic Treatment of Adults in the United States, Journal of Clinical Psychiatry, 76(10):1346-53.