Use of haloperidol and atypical antipsychotic medications for the treatment of agitation

and behavioral and psychological symptoms of dementia (BPSD) indicate small

treatment effects, most evident for aggression, although these must be weighed against
the associated mortality risk (Kales et al, 2012). Atypical antipsychotic drugs have been
widely prescribed for psychosis in dementia, but a meta-analysis of their efficacy
indicated that only aripiprazole and risperidone had a statistically and clinically significant
effect on psychiatric symptoms (Tan et al, 2015). An important caveat to the use of these
medications in dementia is the associated increased risk of death and cerebrovascular
adverse events.
• The literature on antipsychotic treatment in older people with
dementia reveals that although improvement in the behavioral
disturbance was minimal after six to 12 weeks, there was a significant
increase in absolute mortality risk of approximately 1% (Banerjee et
al, 2009). The literature suggests that prescribing antipsychotics in
dementia beyond six to 12 weeks is likely to be substantially harmful
in continued antipsychotic treatment in dementia. Therefore, many
recommend nonpharmacological treatments, such as psychological
and training interventions, to reduce BPSD rather than antipsychotic
management (Duedon et al, 2009). A meta-analysis of the efficacy of
antidepressants in people with dementia was inconclusive (Leong,
2014). Antidepressants have been proposed for the treatment of
BPSD with encouraging results (Henry et al, 2011).