Abstract
Setting
Treating elderly patients with Alzheimer's disease (AD) and behavioral and psychological symptoms of dementia (BPSD) is challenging due to the increased risk of iatrogenic movement disorders with old neuroleptics and the seemingly increasing risk of cardiovascular events with newer atypical agents. Quetiapine is an atypical antipsychotic agent that warrants further investigation.
Objectives
To assess tolerability, safety, and clinical benefit of quetiapine in AD patients with BPSD.
Participants and design
AD patients with BPSD participated in a 6โweek randomized, doubleโblind, placeboโcontrolled trial. Quetiapine was increased on the basis of clinical response and tolerability. Primary efficacy assessments included the Neuropsychiatric Inventory (NPI) and Clinical Global Impression of Change (CGIโC). Secondary efficacy measures included the MiniโMental State Examination (MMSE), the SimpsonโAngus Scale (SAS) and the Abnormal Involuntary Movement Scale (AIMS).
Results
Forty patients (26 women), mean age 82.2 (SD 6.4) years were enrolled, 27 completed treatment. Median dose of quetiapine was 200โmg/day. Significant NPI total scores reductions (79% for placebo and 68.5% for quetiapine) were observed. The CGIโC score decreased significantly in the quetiapine group (pโ=โ0.009 at 6 weeks) and did not change significantly in the placebo group (pโ=โ0.48). The MMSE, AIMS, SAS scores and adverse events did not differ significantly between the two arms.
Conclusions
Quetiapine did not significantly improve psychosis scores. It did not cause cognitive and motor deterioration. These results might possibly be due to small sample size. Copyright ยฉ 2007 John Wiley & Sons, Ltd.