Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-20T23:19:15.118Z Has data issue: false hasContentIssue false
  • English
  • Français

Quetiapine versus risperidone in elderly patients with behavioural and psychological symptoms of dementia: Efficacy, safety and cognitive function

Published online by Cambridge University Press:  04 May 2007

M. Rainer ,
M. Haushofer ,
H. Pfolz ,
C. Struhal  and
W. Wick
M. Rainer*
Affiliation:
Psychiatric Department and Memory-Clinic, Danube Hospital, Langobardenstrasse 122, A-1220Vienna, Austria
M. Haushofer
Affiliation:
Psychiatric Department, Danube Hospital, Vienna, Austria
H. Pfolz
Affiliation:
Psychiatric Department, Otto Wagner Hospital, Vienna, Austria
C. Struhal
Affiliation:
Psychiatric and Neurological Practice, Müllnergasse 26, A-1090Vienna, Austria
W. Wick
Affiliation:
Psychiatric and Neurological Practice, Favoritenstrasse 67, A-1100Vienna, Austria
*
∗Corresponding author. Tel.:+43 1 28802 743011; fax: +43 1 28802 3080. E-mail address: [email protected] (M. Rainer).
Get access

Abstract

Objective

In this study we directly compared the efficacy and tolerability of the atypical antipsychotics quetiapine and risperidone in elderly patients with dementia and symptoms of disturbed perception, thought content, mood or behaviour (behavioural and psychological symptoms of dementia—BPSD).

Methods

We conducted an 8-week, rater-blinded, randomised study of 72 outpatients (55–85 years) with BPSD (assessed by NPI baseline score), who received flexibly-dosed quetiapine (50–400 mg/day) or risperidone (0.5–2 mg/day). Primary efficacy measure: Neuropsychiatric Inventory (NPI) Parts 1 and 2; secondary efficacy measures: Clinical Global Impression (CGI), Cohen-Mansfield Agitation Inventory (CMAI), Mini-Mental State Examination (MMSE), Age-adjusted concentration test (AKT). Safety evaluations included the incidence of extrapyramidal symptoms (EPS) and adverse events (AEs).

Results

Sixty-nine of 72 patients were evaluable for efficacy (72 were evaluated for safety), 4 patients discontinued (3 due to AEs: quetiapine 2, risperidone 1; 1 lost to follow-up). Sixty-five patients received quetiapine (n = 34; mean dose 77 ± 40 mg/day) or risperidone (n = 31; mean dose 0.9 ± 0.3 mg/day). There was no significant difference between treatments on NPI scores; within treatment groups, NPI scores decreased significantly from baseline to Week 8 (P ≤ 0.05 vs. baseline). Most patients (quetiapine arm 67.6%, risperidone arm 71.0%) experienced clinical improvement (CGI-Improvement scores); both agents reduced agitation (CMAI scores); and there was no cognitive impairment (MMSE and AKT scores). There were no significant differences between treatments in any safety measures, including EPS. Four patients experienced serious AEs (quetiapine arm 3; risperidone arm 1); none were considered treatment-related by the study investigator. There were no cerebrovascular AEs or deaths.

Conclusions

Quetiapine or risperidone, at low doses, were equally effective and generally well tolerated (including no cognitive impairment) in the treatment of BPSD in elderly patients.

Keywords

QuetiapineRisperidoneElderlyDementiaBPSDCognition
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 6 , September 2007 , pp. 395 - 403
Copyright
Copyright © Elsevier Masson SAS 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballard, C., Gray, A., Ayre, G.Psychotic symptoms, aggression and restlessness in dementia. Rev Neurol (Paris) 1999;155(Suppl 4):S44–S52.Google ScholarPubMed
Ballard, C., Margallo-Lana, M., Juszczak, E., Douglas, S., Swann, A., Thomas, A.et al.Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. BMJ 2005;330:874.CrossRefGoogle ScholarPubMed
Berger, G., Bernhardt, T., Weimer, E., Peters, J., Kratzsch, T., Frolich, L.Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. J Geriatr Psychiatry Neurol 2005;18:119–128.CrossRefGoogle ScholarPubMed
Brodaty, H., Ames, D., Snowdon, J., Woodward, M., Kirwan, J., Clarnette, R.et al.A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry 2003;64:134–143.CrossRefGoogle ScholarPubMed
Brodaty, H., Draper, B., Saab, D., Low, L.F., Richards, V., Paton, H.et al.Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry 2001;16:504–512.CrossRefGoogle ScholarPubMed
Bullock, R.Treatment of behavioural and psychiatric symptoms in dementia: implications of recent safety warnings. Curr Med Res Opin 2005;21:1–10.CrossRefGoogle ScholarPubMed
Caligiuri, M.R., Jeste, D.V., Lacro, J.P.Antipsychotic-Induced movement disorders in the elderly: epidemiology and treatment recommendations. Drugs Aging 2000;17:363–384.CrossRefGoogle ScholarPubMed
Carson, S., McDonagh, M.S., Peterson, K.A systematic review of the efficacy and safety of atypical antipsychotics in patients with psychological and behavioral symptoms of dementia. J Am Geriatr Soc 2006;54:354–361.CrossRefGoogle ScholarPubMed
Chan, W.C., Lam, L.C., Choy, C.N., Leung, V.P., Li, S.W., Chiu, H.F.A double-blind randomised comparison of risperidone and haloperidol in the treatment of behavioural and psychological symptoms in Chinese dementia patients. Int J Geriatr Psychiatry 2001;16:1156–1162.CrossRefGoogle ScholarPubMed
Cummings, J.L.The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48:S10–S16.Google ScholarPubMed
Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A., Gornbein, J.The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.CrossRefGoogle ScholarPubMed
Dahlke, F., Lohaus, A., Gutzmann, H.Reliability and clinical concepts underlying global judgments in dementia: implications for clinical research. Psychopharmacol Bull 1992;28:425–432.Google ScholarPubMed
De Deyn, P.P., Rabheru, K., Rasmussen, A., Bocksberger, J.P., Dautzenberg, P.L., Eriksson, S.et al.A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999;53:946–955.CrossRefGoogle ScholarPubMed
Ellingrod, V.L., Schultz, S.K., Ekstam-Smith, K., Kutscher, E., Turvey, C., Arndt, S.Comparison of risperidone with olanzapine in elderly patients with dementia and psychosis. Pharmacotherapy 2002;22:1–5.CrossRefGoogle ScholarPubMed
Ferri, C.P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M.et al.Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112–2117.CrossRefGoogle ScholarPubMed
Finkel, S.Introduction to behavioural and psychological symptoms of dementia (BPSD). Int J Geriatr Psychiatry 2000;15(Suppl 1)S2–S4.3.0.CO;2-3>CrossRefGoogle Scholar
Finkel, S., Kozma, C., Long, S., Greenspan, A., Mahmoud, R., Baser, O.et al.Risperidone treatment in elderly patients with dementia: relative risk of cerebrovascular events versus other antipsychotics. Int Psychogeriatr 2005;17:617–629.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., McHugh, P.R.“Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.CrossRefGoogle ScholarPubMed
Fujikawa, T., Takahashi, T., Kinoshita, A., Kajiyama, H., Kurata, A., Yamashita, H.et al.Quetiapine treatment for behavioral and psychological symptoms in patients with senile dementia of Alzheimer type. Neuropsychobiology 2004;49:201–204.CrossRefGoogle ScholarPubMed
Gatterer, G., Fischer, P., Simanyi, M., Danielczyk, W.The A-K-T (“Alters-Konzentrations-Test”) a new psychometric test for geriatric patients. Funct Neurol 1989;4:273–276.Google ScholarPubMed
Goldberg, R.J.Long-term use of risperidone for the treatment of dementia-related behavioral disturbances in a nursing home population. Int J Geriatr Psychopharmacol 1999;2:1–4.Google Scholar
Jellinger, K.A.Clinicopathological analysis of dementia disorders in the elderly—An update. J Alzheimers Dis 2006;9:61–70.Google ScholarPubMed
Jeste, D.V., Rockwell, E., Harris, M.J., Lohr, J.B., Lacro, J.Conventional vs. newer antipsychotics in elderly patients. Am J Geriatr Psychiatry 1999;7:70–76.CrossRefGoogle ScholarPubMed
Katz, I.R., Jeste, D.V., Mintzer, J.E., Clyde, C., Napolitano, J., Brecher, M.et al.Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. J Clin Psychiatry 1999;60:107–115.CrossRefGoogle ScholarPubMed
Koss, E., Weiner, M., Ernesto, C., Cohen-Mansfield, J., Ferris, S.H., Grundman, M.et al.Assessing patterns of agitation in Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory. The Alzheimer's Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997;11(Suppl 2):S45–S50.CrossRefGoogle ScholarPubMed
Lawlor, B.Managing behavioural and psychological symptoms in dementia. Br J Psychiatry 2002;181:463–465.CrossRefGoogle ScholarPubMed
Lee, P.E., Gill, S.S., Freedman, M., Bronskill, S.E., Hillmer, M.P., Rochon, P.A.Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ 2004;329:75.CrossRefGoogle ScholarPubMed
Livingston, G., Walker, A.E., Katona, C.L., Cooper, C.Antipsychotics and cognitive decline in Alzheimer's disease: The LASER-AD longitudinal study. J Neurol Neurosurg Psychiatry 2006.Google Scholar
Lobo, A., Launer, L.J., Fratiglioni, L., Andersen, K., Di Carlo, A., Breteler, M.M.et al.Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000;54:S4–S9.Google ScholarPubMed
Margallo-Lana, M., Swann, A., O'Brien, J., Fairbairn, A., Reichelt, K., Potkins, D.et al.Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. Int J Geriatr Psychiatry 2001;16:39–44.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
McKeith, I., Cummings, J.Behavioural changes and psychological symptoms in dementia disorders. Lancet Neurol 2005;4:735–742.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M.Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939–944.CrossRefGoogle ScholarPubMed
McShane, R., Keene, J., Gedling, K., Fairburn, C., Jacoby, R., Hope, T.Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up. BMJ 1997;314:266–270.CrossRefGoogle ScholarPubMed
Mintzer, J, Zhong, K, Tariot, P, Minkwitz, M, Devine, NA. Quetiapine in the treatment of agitation in Alzheimer's disease patients. Poster presented at the 36th Annual Meeting of the American Society of Consultant Pharmacists (ASCP), Boston, MA, USA, 9–12 November, 2005.Google Scholar
Rainer, M.K., Kruger-Rainer, C., Haushofer, M., Mucke, H.A.Zotepine for behavioural and psychological symptoms in dementia: an open-label study. CNS Drugs 2004;18:1165.CrossRefGoogle Scholar
Rainer, M.K., Masching, A.J., Ertl, M.G., Kraxberger, E., Haushofer, M.Effect of risperidone on behavioral and psychological symptoms and cognitive function in dementia. J Clin Psychiatry 2001;62:894–900.CrossRefGoogle ScholarPubMed
Rojas-Fernandez, C.H., Lanctot, K.L., Allen, D.D., MacKnight, C.Pharmacotherapy of behavioral and psychological symptoms of dementia: time for a different paradigm?. Pharmacotherapy 2001;21:74–102.CrossRefGoogle ScholarPubMed
Schneider, L.S., Dagerman, K.S., Insel, P.Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294:1934–1943.CrossRefGoogle ScholarPubMed
Schneider, L.S., Pollock, V.E., Lyness, S.A.A metaanalysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990;38:553–563.CrossRefGoogle ScholarPubMed
Schneider, L.S., Tariot, P.N., Dagerman, K.S., Davis, S.M., Hsiao, J.K., Ismail, M.S.et al.Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med 2006;355:1525–1538.CrossRefGoogle ScholarPubMed
Schneider, LS, Tariot, P, Mintzer, J, Minkwitz, MC, Zhong, K. Risks for cerebrovascular adverse events: use of quetiapine in patients with dementia. Poster presented at the 158th Annual Meeting of the American Psychiatric Association, Atlanta, GA, USA, 21–26 May, 2005.Google Scholar
Sink, K.M., Holden, K.F., Yaffe, K.Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005;293:596–608.CrossRefGoogle Scholar
Street, J.S., Clark, W.S., Gannon, K.S., Cummings, J.L., Bymaster, F.P., Tamura, R.N.et al.Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities. A double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 2000;57:968–976.Google ScholarPubMed
Street, J.S., Clark, W.S., Kadam, D.L., Mitan, S.J., Juliar, B.E., Feldman, P.D.et al.Long-term efficacy of olanzapine in the control of psychotic and behavioral symptoms in nursing home patients with Alzheimer's dementia. Int J Geriatr Psychiatry 2001;16(Suppl 1):S62–S70.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Tariot, P.N., Salzman, C., Yeung, P.P., Pultz, J., Rak, I.W.Long-term use of quetiapine in elderly patients with psychotic disorders. Clin Ther 2000;22:1068–1084.CrossRefGoogle ScholarPubMed
Wancata, J., Musalek, M., Alexandrowicz, R., Krautgartner, M.Number of dementia sufferers in Europe between the years 2000 and 2050. Eur Psychiatry 2003;18:306–313.CrossRefGoogle ScholarPubMed
Wimo, A., Winblad, B., Aguero-Torres, H., von Strauss, E.The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord 2003;17:63–67.CrossRefGoogle Scholar
Wooltorton, E.Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. Can Med Assoc J 2002;167:1269–1270.Google ScholarPubMed
Wooltorton, E.Olanzapine (Zyprexa): increased incidence of cerebrovascular events in dementia trials. Can Med Assoc J 2004;170:1395.CrossRefGoogle ScholarPubMed
Zhong, K., Tariot, P., Minkwitz, M., Devine, N., Mintzer, J.Quetiapine in the treatment of agitation in patients with Alzheimer's disease. J Am Geriatr Soc 2005;53(Suppl 1):S27 abstr A26.Google Scholar
Submit a response

Comments

No Comments have been published for this article.