General practice Terapia 2020, 6 ( 389 ) : 60 - 68
Agitated patient with dementia - pharmacotherapy and strategy for its optimization
Summary:
Approximately 13‒80% patients with dementia present neuropsychiatric symptoms. Patients suffer from single ailments such as insomnia, agitation, aggression or anxiety or symptoms fulfilling the criteria of behavioral and psychological symptoms of dementia (BPSD). Caring for people with BPSD requires the cooperation of a multidisciplinary team of specialists, nonetheless a primary care physician plays a major role in the diagnostic and treatment processes. Available data suggests, that the treatment of patients with BPSD is oftentimes not in line with current medical knowledge and expert’s guidelines. Research of the elderly population shows, that both the use of antipsychotics and benzodiazepines is associated with increased risk of complications and mortality. Yet, the treatment of people with BPSD all too often consists of antipsychotics. These are prescribed despite there being no adequate indications, used in too high doses and for periods of time exceeding these which are currently indicated. Benzodiazepines too, are overprescribed in this population. There are, however, other drugs available for relatively effective and safe treatment of BPDS. The first one is tiapride. It’s an atypical antipsychotic but it’s unique pharmacodynamic and pharmacokinetic profile facilitates an effective and welltolerated treatment. It’s recommended as one of first options for treatment of patients with agitation, aggression and insomnia in Alzheimer’s disease. Another medication providing an effective and safe therapeutic option is trazodone. This work discusses the matter of pharmacotherapy of BPSD: indications for it, efficacy, safety and strategies for optimization.
Keywords: behavioral and psychological symptoms of dementia, geriatrics, pharmacotherapy, tiapride, trazodone
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