Use of antipsychotics in elderly patients with dementia: do atypical and conventional agents have a similar safety profile?

G Trifirò, E Spina, Giovanni Gambassi

Risultato della ricerca: Contributo in rivistaArticolo in rivista

74 Citazioni (Scopus)


Pharmacological treatment of dementia addresses two main clinical features of the disease: cognitive deterioration with predominantly memory loss and behavioural and psychological symptoms (BPSD). While cholinesterase inhibitors are recommended in an attempt to delay memory loss and disability, what should be considered the most appropriate pharmacological treatment for BPSD has remained questionable. Antipsychotic medications, conventional and atypical agents, have been increasingly utilized in clinical practice but only a small number of clinical studies have investigated their relative cost-benefit ratio. This review focuses on the safety of atypical and conventional antipsychotics when used in patients with BPSD. Overall, atypical and conventional antipsychotics are associated with a similarly increased risk for all-cause mortality and cerebrovascular events. Relative to atypical agents users, patients being treated with conventional antipsychotics have an increased incidence of cardiac arrhythmias and extrapyramidal symptoms. Conversely, users of atypical antipsychotics are exposed to an increased risk of venous thromboembolism and aspiration pneumonia. Also, metabolic effects (i.e. increased risk of diabetes, weight gain) have consistently been documented in clinical studies with atypical antipsychotics, although this effect tends to be attenuated with advancing age and in elderly patients with dementia. Antipsychotics, both conventional and atypical, should be used with caution only when nonpharmacologic approaches have failed to adequately control BPSD. More effective interventions are necessary to improve postmarket drug safety in vulnerable populations.
Lingua originaleEnglish
pagine (da-a)1-12
Numero di pagine12
RivistaPharmacological Research
Stato di pubblicazionePubblicato - 2009


  • Accidental Falls
  • Antipsychotic Agents
  • Arrhythmias, Cardiac
  • Basal Ganglia Diseases
  • Dementia
  • Humans
  • Hyperprolactinemia
  • Ischemic Attack, Transient
  • Metabolic Diseases
  • Pneumonia
  • Stroke
  • Venous Thromboembolism


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