PSYCHOPHARMACOLOGY OF NONCOGNITIVE ABNORMAL BEHAVIORS IN ALZHEIMERS-DISEASE

Disruptive agitation and psychotic symptoms are important problems in the management of Alzheimer's disease and are major determinants of nu rsing home placement. This article reviews interpretable, placebo-cont rolled studies of psychopharmacologic approaches to the treatment of t hese ''noncognitive'' psychiatric and behavioral problems. Clinical tr ials of antipsychotic drugs demonstrate modest efficacy for psychosis and agitation, but adverse effects are common. Trials of serotonin sel ective reuptake inhibitors suggest they may be effective for emotional disturbances complicating Alzheimer's disease. Trials of drugs that e nhance central cholinegic activity (certain cholinesterase inhibitors and selective M-1 muscarinic cholinergic agonists) demonstrate positiv e effects on both cognitive deficits and noncognitive psychiatric and behavioral problems. Further clinical studies are needed to provide gu idelines for the management of noncognitive psychiatric and behavioral problems in Alzheimer's disease.