First well-conducted studies of use of antipsychotics in people with Alzheimer’s

A member of a class of drugs that are widely prescribed for abnormal behavioral symptoms in Alzheimer’s – but not often studied in people with the degenerative brain disease – proved to be effective and well tolerated in treating agitation in people with severe Alzheimer’s, according to research reported at The 9th International Conference on Alzheimer’s Disease and Related Disorders (ICAD) in Philadelphia, presented by the Alzheimer’s Association.

Although Alzheimer’s is best known for its effects on memory, as the disease progresses, individuals often experience severe agitation or symptoms of psychosis. Doctors often prescribe antipsychotic drugs to alleviate these symptoms. Quetiapine (Seroquel, AstraZeneca) is one of the newer choices, and two related AstraZeneca-funded studies presented at ICAD address questions about its effectiveness and safety. Earlier studies suggested that drugs similar to quetiapine might increase risk of stroke in older adults.

In a 10-week multicenter study, researchers assessed the effects of quetiapine in 333 elderly, institutionalized patients with severe Alzheimer's. Pierre Tariot, M.D., of the University of Rochester Medical Center, Rochester, NY, and colleagues reported significantly better scores on several indices of agitation among patients receiving quetiapine (200 mg/day) versus placebo. They reported no significant safety issues, especially strokes or transient ischemic attacks (TIAs, “mini-strokes”). This latter concern was addressed more directly in a separate analysis of data also presented at ICAD.

Led by Lon Schneider, MD, of the University of Southern California in Los Angeles, researchers pooled data from the above-referenced study and another 10-week study of quetiapine for agitation, looking for evidence of an increased risk of stroke or TIA associated with use of the drug. Both studies were conducted among institutionalized patients, and the average age was 83 years. Most of the 684 patients had Alzheimer's disease, though a minority had other types of dementia.

"Although the studies were not designed with the primary purpose of evaluating the incidence of these side-effects and the sample sizes were small, the data available so far are compatible with no increased risk for cerebrovascular adverse events with quetiapine in this population," said Schneider.

“Currently, there is broad use of antipsychotics in Alzheimer’s disease for symptoms such as anxiety, sleep disturbances, delusions and hallucinations,” said Sam Gandy, M.D., Ph.D., of the Alzheimer’s Association’s Medical & Scientific Advisory Council. “However, these drugs have not been extensively tested in people with Alzheimer’s. So, questions remain about effectiveness and proper dosing levels, and clinicians need guidance. These studies are some of the first well-conducted studies of these drugs in people with Alzheimer’s.”

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