olanzapine and Dementia--Vascular

The objective of the present study is to systematically review the supporting evidence for the use of antipsychotics in the treatment of behavioral and psychological symptoms in patients with dementia, as well as the controversies and limitations of this prescription. We discuss the available evidence in the light of the high prevalence of behavioral and psychological symptoms of dementia in this population, along with the greater susceptibility of elderly patients to adverse events.. Systematic literature review of the use of typical and atypical antipsychotics in patients with dementia was carried out in the databases PubMed/Medline, Embase and SciELO. The search was limited to clinical trials and meta-analysis of the literature published from 1986 to 2007.. Evidence drawn from randomized, double-blind, placebo controlled trials support the use of both typical and atypical antipsychotics in the treatment of behavioral symptoms of dementia, especially psychotic symptoms and abnormal psychomotor activity. Nevertheless, the use of these drugs in demented patients is not devoid of important adverse events. Although the induction of extrapyramidal symptoms is not as frequent or severe with atypical antipsychotics as it is with first-generation neuroleptics, the former drugs may particularly increase the risk of cerebrovascular events and death.. Although effective, antipsychotic drugs must be prescribed cautiously in patients with dementia. Dose regimens, duration of treatment and a cautious assessment of risk-benefit must be established for each patient.

Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Cerebrovascular Disorders; Dementia; Dementia, Vascular; Dibenzothiazepines; Double-Blind Method; Evidence-Based Medicine; Haloperidol; Humans; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Randomized Controlled Trials as Topic; Risperidone; Treatment Outcome

Drug-induced iatrogenic hallucinations and psychosis occur in about 30% of Parkinson's disease (PD) patients and are the single most important precipitant for nursing home placement, which carries a grave prognosis. In addition, parkinsonism is a frequent accompaniment to the more common dementing syndromes, Alzheimer's disease (AD), vascular dementia, and dementia with Lewy bodies (DLB). The five most recent antipsychotic drugs approved by the Food and Drug Administration in the United States have been marketed as "atypical" antipsychotics (AA) due to their relative freedom from extrapyramidal symptoms when used in schizophrenia patients. The use of these newer antipsychotic drugs in PD and other parkinson-sensitive populations represents the most stringent test to their freedom from motor side effects. To date, clozapine, risperidone, olanzapine, and quetiapine have been studied in parkinson-vulnerable populations. This article reviews the data and highlights the differences that these four drugs have on motor function. It also emphasizes the challenges in evaluating the available data on the motor effects of AA, especially on the non-PD elderly and cognitively impaired population. Suggestions are made for future research to improve the interpretability of these studies.

Topics: Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Clozapine; Dementia, Vascular; Dibenzothiazepines; Hallucinations; Humans; Iatrogenic Disease; Lewy Body Disease; Olanzapine; Parkinson Disease; Pirenzepine; Psychotic Disorders; Quetiapine Fumarate; Risperidone

The authors compared efficacy of olanzapine versus placebo and risperidone as measured by the Neuropsychiatric Inventory and Clinical Global Impression-Severity of Psychosis scale in patients with dementia-related psychosis.. Patients with moderate-to-severe psychotic symptoms associated with dementia were recruited from outpatient or residential settings and randomly assigned to 10-week, double-blind, flexible-dose treatment with olanzapine (N=204; 2.5 mg-10 mg/day; mean: 5.2 mg/day), risperidone (N=196; 0.5 mg-2 mg/day; mean: 1.0 mg/day) or placebo (N=94).. Most measures of neuropsychiatric functioning improved in all treatment groups, including the placebo group, and no significant treatment differences occurred. Overall discontinuation was lowest in the placebo group, and the olanzapine group had a significantly higher incidence of discontinuation due to adverse events (16.2%) relative to placebo (3.2%) and risperidone (8.7%) groups. Treatment-emergent extrapyramidal symptoms were more numerous for risperidone- than placebo- or olanzapine-treated patients. Abnormally high prolactin levels occurred in 78.0% of risperidone patients, compared with 16.7% for olanzapine and 5.0% for placebo. The incidence of weight gain greater than 7% from baseline was higher in the olanzapine group relative to risperidone, but neither active-treatment group showed a statistical difference from placebo (1.1%). No other statistically significant and clinically relevant differences were seen for any other vital sign, electrocardiographic measure, or laboratory hematology and chemistry, including glucose, except for cholesterol, which decreased from baseline to endpoint in both active-treatment groups.. Patients' neuropsychiatric functioning improved with olanzapine, risperidone, and placebo treatment. There was a substantial response in the placebo group, and no significant differences emerged among treatments.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Brief Psychiatric Rating Scale; Comorbidity; Conduct Disorder; Dementia, Vascular; Depressive Disorder, Major; Double-Blind Method; Female; Humans; Male; Neuropsychological Tests; Olanzapine; Psychomotor Agitation; Risperidone; Treatment Outcome

The behavioral and psychological symptoms of dementia present a major challenge in the management of these patients. There is no Food and Drug Administration-indicated medication for the management of these symptoms. Even though atypical antipsychotics are considered safer than conventional antipsychotics, safety concerns have emerged.. The FDA has issued warnings regarding the cardiac and metabolic side effects, cerebrovascular events, and, most recently, mortality risk. This study was conducted in 2003 when physicians were notified of the cerebrovascular risks of risperidone. Since then, similar warnings have been issued for olanzapine and aripiprazole.. The medical records of 58 elderly dementia patients who were taking risperidone and were abruptly switched to olanzapine were reviewed. Clinical Global Impressions scale at assigned retrospectively at switch, and weeks 4-6 assessed treatment.. Baseline and follow-up Clinical Global Impressions scale scores were essentially unchanged. Adverse events were mild to moderate in severity. Mean risperidone dose at switch was 1.54 mg/day (range: 0.25-6 mg/day). Mean olanzapine dose after the switch was 5.69 mg/day (range: 2.52-27.5 mg/day).. Most of the 58 patients were switched from risperidone to olanzapine without any deterioration in their clinical status. Even though it is generally not recommended in elderly patients, abrupt switching did not have any negative consequences in this group of patients.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Benzodiazepines; Comorbidity; Dementia, Vascular; Dose-Response Relationship, Drug; Drug-Related Side Effects and Adverse Reactions; Female; Follow-Up Studies; Homes for the Aged; Humans; Male; Nursing Homes; Olanzapine; Psychotic Disorders; Retrospective Studies; Risk Factors; Risperidone; Schizophrenia; Treatment Outcome

The credibility of an increased risk of cerebrovascular events (CVEs) in elderly patients with dementia being treated with second-generation antipsychotics (SGAs) is debatable. Although early published and unpublished data indicated a risk, much of the subsequent literature has not supported this initial finding. Previously published studies were flawed in part because they lacked a control group and did not stratify by dementia subtype. This study examined the risk of a CVE in patients diagnosed with Alzheimer or vascular dementia while being treated with SGA, first-generation antipsychotics, or no antipsychotic medication.. Data from 14,029 patients aged 65 years and older were evaluated using patient information from Veterans Administration and Medicare databases. Patients who received care for dementia were categorized according to dementia subtype (vascular or Alzheimer) and antipsychotic use during an 18-month period. Patients were observed until they were admitted to a hospital for a CVE, stopped taking or switched antipsychotics, died, or until the 18-month observation period ended.. Overall, CVE risk did not differ whether patients were receiving a first-generation antipsychotic, SGA, or no antipsychotic therapy. However, patients with vascular dementia had an increased risk in hospitalization for a CVE. There was no increase in risk of a CVE for patients treated with quetiapine, olanzapine, or risperidone relative to haloperidol, or for patients receiving olanzapine or risperidone relative to quetiapine. Stratified subgroup analyses demonstrated no difference in risk for CVE-related admission patients with Alzheimer dementia among individual agents. However, patients with vascular dementia receiving risperidone, but not olanzapine or quetiapine, were found to be at decreased risk for CVE admission relative to haloperidol.. This study found no increase in overall risk for CVE-related hospital admission in patients treated with antipsychotic medications.

Topics: Aged; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Databases, Factual; Dementia, Vascular; Dibenzothiazepines; Female; Haloperidol; Humans; Kaplan-Meier Estimate; Male; Medicare Part A; Multivariate Analysis; Olanzapine; Quetiapine Fumarate; Risk Assessment; Risk Factors; Risperidone; Treatment Outcome; United States; United States Department of Veterans Affairs; Veterans

Topics: Aged; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Cause of Death; Controlled Clinical Trials as Topic; Dementia, Vascular; Humans; Olanzapine; Psychotic Disorders; Risk; Risperidone; Statistics as Topic; Stroke; Survival Analysis

The case presented highlights the difficult differential diagnosis of memory-sparing cognitive decline in an elderly patient with previously stable bipolar illness. Many disorders can contribute to cognitive and behavioral deterioration in this population, including reversible causes, particularly delirium and psychiatric illness, and irreversible structural or progressive processes including vascular disease, dementia with Lewy bodies, normal-pressure hydrocephalus, and frontotemporal dementia.

Topics: Age of Onset; Aged; Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Brain; Cognition Disorders; Dementia; Dementia, Vascular; Disease Progression; Humans; Lithium Compounds; Male; Memory; Mental Disorders; Neuropharmacology; Olanzapine; Psychoses, Substance-Induced; Recovery of Function

Behavioral problems produce excess disability, potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisia. We followed up (for 12 months) a group of 346 consecutive outpatients, with a diagnosis of subcortical vascular dementia or multi-infarctual dementia. Patients eligible for this open-label study were required to have behavioral problems (BPSD). Patients were divided into two groups, Group A received olanzapine 2.5-7.5 mg/day while Group B received typical antipsychotics. Patients in both groups were allowed to continue any previous therapy. Patients in both groups were significantly improved in their BPSD. Our patients had a host of medical conditions and received numerous concomitant medications. Given the potential complications associated with these therapeutic agents, these patients tolerated olanzapine quite well. On examination of consequences of adverse events, particularly somnolence, postural instability, and postural hypotension, it appeared that cerebrovascular events were not present. Moreover, no anticholinergic effect was recorded. These findings suggest that olanzapine could be a safe and effective treatment even for elderly population in suitable doses and receiving the adequate follow-up.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Behavioral Symptoms; Benzodiazepines; Dementia, Vascular; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Olanzapine; Randomized Controlled Trials as Topic; Risk Factors; Selective Serotonin Reuptake Inhibitors; Stroke; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Cerebral Infarction; Dementia, Vascular; Humans; Olanzapine; Psychotic Disorders; Randomized Controlled Trials as Topic; Risk Factors; Risperidone; Treatment Outcome

The case of a 73-year-old male with delusions of parasitosis (DP) is presented. He complained about severe itching of the limbs and the genital region as well as abnormal body and pubic hair that he believed to be parasites. The symptoms occurred over the course of several years together with severe heart diseases (New York Heart Association class III, atrial fibrillation, tricuspid regurgitation) and chronic edema of the lower leg. The pruritus was also based on chronic, self-induced skin lesions due to aggressive disinfection and tearing out of body hair. After ruling out true infection, a multimodal DP therapy was initiated. Instead of the standard neuroleptic drug pimozide, olanzapine was used because of its better tolerability in patients with increased cardiac risk (i.e., borderline prolonged QTc time). At discharge, the DP had partially remitted. Substantial improvement in the heart and skin diseases under specific treatment contributed substantially to the success of the therapeutic regimen. This case hints at (1) the effectiveness of olanzapine in DP and (2) the importance of general medical conditions in the therapeutic approach to DP.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Comorbidity; Delusions; Dementia, Vascular; Drug Interactions; Ectoparasitic Infestations; Electrocardiography; Heart Failure; Humans; Long QT Syndrome; Male; Olanzapine; Patient Care Team; Pirenzepine; Pruritus; Self-Injurious Behavior

Orally disintegrating olanzapine is a recently marketed form of olanzapine that dissolves rapidly on contact with saliva. We describe six demented patients resistant to treatment with common oral antipsychotic medications who were successfully treated with the formulation. The importance of these case reports is to make physicians aware that orally disintegrating olanzapine may be useful for the management of psychobehavioral disturbances in demented patients who resist or have difficulty taking standard oral medications.

Topics: Administration, Oral; Aged; Aged, 80 and over; Alzheimer Disease; Antipsychotic Agents; Benzodiazepines; Biological Availability; Brain Injury, Chronic; Dementia; Dementia, Vascular; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Male; Mental Disorders; Mental Status Schedule; Olanzapine; Pirenzepine; Psychotic Disorders; Treatment Outcome