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Risperidone in Alzheimer's Disease

Risperidone in Alzheimer's Disease

Antipsychotic medications are commonly used to treat behavioral symptoms in Alzheimer's disease.Psychosis, which can include hallucinations, delusions, paranoia, aggression, and agitation, is common in Alzheimer's disease, particularly in the later stages. The antipsychotic drugs used to treat these symptoms include both traditional antipsychotic drugs like haloperidol (Haldol) and atypical antipsychotic drugs like risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine fumarate (Seroquel). Medical experts believe that the improper and illegal prescription of anti-psychotic medications for Alzheimer's patients in nursing homes and other healthcare facilities is an unfortunate problem. Caregivers should be made aware of the various options for treating behavioral symptoms before they request medical intervention for their Alzheimer's patients.

Efficacy of Risperidone in Alzheimer's Disease

The efficacy of risperidone in patients with dementia was established in three 12-week studies in patients diagnosed with a DSM-IV diagnosis of dementia of the Alzheimer's type and at least one behavioral disturbance. In the intent-to-treat population using baseline observation carried forward at 12 weeks, risperidone was significantly more effective than placebo on the Cohen-Mansfield Agitation Inventory, but not on the Neuropsychiatric Inventory (2.8 units/day vs 1.9 units/day, p=0.001 versus 1.5 units/day vs 1.3 units/day). Risperidone also significantly improved most co-primary measures, as demonstrated by the : Clinical Global Impression of Change in the intent-to-treat populations using last observation carried forward were different, but still within the scoring ranges for "minimal", "much" and "very much improved" (2.3 vs 2.5). Different doses work differently for different people.

These scales were not originally designed for use in elderly patients (with and without dementia) and, in this case, the scales are not indicative enough to predict association. A secondary analysis of covariance, adjusting for five baseline factors, shortened the statistical significance, but demonstrated that risperidone was still more effective than placebo on most co-primary outcome measures. At low risk of liver enzyme elevations and hyperprolactinemia, risperidone is an effective treatment for the management of the behaviors associated with dementia of the Alzheimer's type. However, Risperidone has not been shown to be safe or effective in the treatment of patients with dementia-related psychosis.

Clinical Trials Evaluating Risperidone

Positive results and statistically significant improvement in MCST were gathered by two weeks and throughout the twelve week trial in the risperidone group compared to the placebo group according to a trial conducted at Maudsley Hospital, London. Furthermore, the NPI has been widely used to rate severity and occurrence of many behavioral and psychotic symptoms in patients with dementia. All trials mentioned in this report have used the NPI to some extent as a means of assessing behavioral symptoms in patients with Alzheimer's disease. To assess the efficacy of risperidone in the treatment of psychotic symptoms the Brief Psychiatric Rating Scale (BPRS) was utilized during the double-blind phase of a trial at Maudsley Hospital, London, England.

Effectiveness of Risperidone in Managing Behavioral Symptoms

Despite the widespread use of risperidone to manage the behavioral symptoms associated with AD, there is limited evidence supporting its efficacy for this purpose. The few randomized controlled trials that exist have been small and show little benefit. The first large, double-blind placebo-controlled trial found little difference in the primary outcome measure of aggression and psychosis between the risperidone group and the placebo group after 12 weeks of treatment. In fact, when one considers the individual components of aggression and psychosis, both were found to be significantly worse in the risperidone group compared to the placebo group.

risperidone in alzheimer disease

Potential Benefits and Risks of Risperidone Use

The potential benefits of treating Alzheimer's disease with risperidone are relatively well established. Many studies confirm the drug's effectiveness in decreasing the severity of psychotic symptoms and improving agitation and aggression. Evidence for the benefits of risperidone treatment in Alzheimer's disease, however, varies widely from one patient to another and from one study to another. Due to this variability, risks of risperidone treatment in Alzheimer's disease have been more consistently substantiated, but are thus better understood. While these risks are relatively minimal, they are significant and must be carefully weighed in light of the possible benefits. Some common undesired effects of risperidone include sedation and dizziness, urinary problems and an increased risk of cardiovascular disorders. Whilst rare, potentially serious side effects of this drug include neuroleptic malignant syndrome, torsades de pointes, parkinsonism and impotence/menstrual irregularity. Other commonly-cited risks of risperidone may include a possible decrease in cognition and a possible increased risk of stroke. It is thus auspicable to keep the use of antipsychotic medication for Alzheimer's disease to a minimum.

Safety and Side Effects of Risperidone in Alzheimer's Disease

Common Side Effects of Risperidone

Some common side effects of Risperidone that patients complain of include feeling drowsy or exhausted, stomach pain, diarrhoea, constipation or feeling sick (nausea) and vomiting. The person might put on weight or have difficulty swallowing which is when the person might choke or have chest infections. Other common side effects include producing more saliva, sweating, having trouble sleeping, feeling very anxious or overexcited, developing muscle weakness or an irregular heart beat, developing bladder and bowel problems and swelling of the hands, feet and ankles.

Risk of Adverse Events in Elderly Patients

Therefore, manic reactions, aggression, delusions, hallucinations, hostility, and uncooperativeness. This can pose a heightened medical risk for elderly patients, and so, special care must be taken with this population, due to the known risks. There is an increase in all cause mortality, infectious and cardiovascular-related events placing elderly patients at further risk. Middle or older aged patients seem, however, to be at the highest risk in comparison with other age groups.

Furthermore, the onset of all-cause mortality seems to be increased within the first thirty days of treatment, with the risk becoming evident soon after the commencement of treatment and during the first months, in particular. For any deaths that have been recorded within 180 days post-incident, strokes and/or cardiovascular-related deaths are marked.

Furthermore, adverse events are concentrated in the initial phase of treatment, specifically in the first month, during which the most severe adverse effects occur. It should be noted that overall, the incidence rate of adverse effects is greater for elderly patients. Recognizing these findings, healthcare professionals advise that elderly patients are prescribed Risperidone only after careful consideration.

Monitoring and Management of Side Effects

Risperidone has certain common side effects, as mentioned in Section 3.1, and the risk of AEs is greater in elderly patients, as mentioned in Section 3.2. To mitigate these risks, and to ensure patient safety, close monitoring of the patient is necessary. There should be detailed history - thorough systemic and physical examination, lab investigations to rule out any abnormal biochemistry or endocrinopathy, if possible neuroimaging and electroencephalography in case of seizure episodes, should be sought. If the patient has had a Primarily Generalized Tonic clonic Seizure (PGTS) an epilepsy assessment should follow five years after the event. If the symptoms are recurrent, an EMG/NCS may be sought. Neuroimaging may include MRI, cerebral angiography, EEG for neural atypical behaviors or neurocognitive dysfunction etc. In appropriate circumstances, urinary copper measured as sternly implied from the clinical condition.

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