Demented patients are often treated nonspecifically with psychoactive medications. Neuroleptic drugs are given even when they are not specifically indicated, as Tomislav Majic and his colleagues from the Charité Hospital, Berlin, show in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2010; 107[18]: 320-7).
As dementia worsens, neuropsychiatric symptoms such as depression, apathy, and aggressiveness become more common. These cause suffering, not just for the patient, but also for the nursing staff and for the patient's fellow elderly home residents. In this cross-sectional study, the authors analyzed data on 304 demented patients from 18 homes for the elderly in Berlin. More than half of them were being treated with neuroleptic drugs; on the other hand, anti-dementia drugs were only rarely prescribed, despite evidence of their effectiveness in severe dementia.
Psychoactive drugs can have serious side effects that increase the risk of death. The authors recommend, therefore, that they be used with specific goals in mind, in accordance with existing guidelines. Other, complementary therapies, not necessarily pharmacological, should also be considered.
New neuroimaging marker may identify persons at risk of dementia in future clinical trials