The effects of olanzapine in reducing the emergence of psychosis among nursing home patients with Alzheimer's disease

Background: Elderly patients with Alzheimer's disease (AD) commonly exhibit psychotic symptoms, prompting clinicians to administer antipsychotics. Thi s article compares the effects of olanzapine and placebo in the emergence o f hallucinations or delusions in AD patients with symptoms of agitation/agg ression but little or no psychotic symptomatology at baseline. Method: A multicenter, double-blind, placebo-controlled study was conducted in nursing home patients with AD according to DSM-IV criteria and symptoms of agitation/agression and/or psychosis. Patients (N = 206) were randomly assigned to receive either placebo or fixed-dose olanzapine (5, 10, or 15 m g/day) for up to 6 weeks. This article analyzes data from a subgroup of pat ients (N = 165) with no or minimal delusions and/or hallucinations at basel ine as measured by the Neuropsychiatric Inventory Nursing Home Version (NPI /NH). Three subsets of patients were identified on the basis of their sympt oms at baseline: those with no clinically significant hallucinations, those with no clinically significant delusions, and those with no clinically sig nificant delusions or hallucinations. Results: Of the patients without hallucinations or delusions at baseline (N = 75), the placebo-treated patients showed significantly greater developme nt of these symptoms compared with olanzapine-treated patients overall (NPI /NH hallucinations + delusions mean change score, +2.73 vs. +0.27, p = .006 ). Similarly, of the patients without baseline hallucinations (N = 153), th e placebo-treated patients showed greater hallucinations score increases th an did olanzapine-treated patients overall (+1.25 vs. +0.33, p = .026), whe reas patients without baseline delusions (N = 87) showed no significant tre atment effects. Olanzapine had a favorable safety profile in each patient s ubset. Conclusion: These results suggest that, overall, olanzapine effectively att enuated emergence of psychosis in a short-term trial of patients with alzhe imer's disease.