FROM TRANSMITTERS TO TREATMENT - THE PHARMACOTHERAPY OF BEHAVIORAL DISTURBANCES IN DEMENTIA

Background: Behavioural disturbances in dementia are a common cause of excess morbidity, impairing the quality of life for both patient and caregiver. As part of a comprehensive approach to management, which in cludes a search for underlying causes and behavioural interventions, p harmacotherapy can be extremely helpful in alleviating symptoms such a s agitation, aggression, and psychosis. Method: This paper reviews rec ent studies that examine the neurochemical basis of these behavioural disturbances in order to provide a rationale for the various classes o f psychotropics which have been used. Results: While neuroleptics have been the best-studied class of drugs to date, modest efficacy and sig nificant potential side effects often limit their use. Newer atypical neuroleptics may be better tolerated, though controlled data have yet to be published There is increasing support for the use of carbamazepi ne and antidepressants such as trazodone and the selective serotonin r euptake inhibitors (SSRIs). Conclusion: Further controlled studies of all of these agents are required in order to determine whether transmi tter-specific or behaviour-specific targeted interventions truly provi de a rationale for the effective pharmacotherapy of these disorders.