Risperidone in the treatment of behavioral disorders in elderly patients with dementia

The aim of the present study was to evaluate the efficacy of risperidone in the treatment of behavioral disorders in elderly patients with dementia. T hirteen patients with diagnosis of dementia, 7 men (53.8 %) and 6 women (46 .2 %), mean age 76.5 +/- 6.3 years, were selected from "Casa di Cura S. Vin cenzo", Catanzaro, and from the Medicine Unit of "Ospedale Maria Vittoria", Torino. To evaluate behavioral disturbances, the UCLA Neuropsychiatric Inv entory (NPI) was administered at start, and after 4 and 8 weeks. After a wa sh-out period of 10 days, risperidone was administered in doses of 1 mg/day in the morning; in case of lack of clinical response, dose could be increa sed to 2 mg/day in divided doses (morning and bedtime) after 4 weeks. Conco mitant use of other antipsychotics, antidepressants, mood stabilizers was a voided. Lorazepam (1 to 3 mg/day) could be administered in case of need unt il the end of the first two weeks. Repeated measure analysis of variance (A NOVA) was used for the statistical evaluation of rating scale scores over t ime. A good response to risperidone was present in 9 of 13 patients (69.2 % ), 5 men and 4 women, a partial response in 3 patients (23.1 %), 2 men and 1 woman and no response in 1 woman (7.7 %). The main results were obtained on agitation, anxiety, euphoria, disinhibition, irritability and wandering. Mean score of NPI was 46.7 +/- 6.9 at start, 14.7 +/- 5.2 after 4 weeks an d 11.4 +/- 5.8 after 8 weeks. The decreases in mean score during treatment were significant (p < 0.0001). The plasma concentrations of risperidone plu s 9-OH-risperidone ranged from 11.5 to 20 nmol/l. To be noticed, the Mini M ental State Examination (MMSE) score did not worsen after risperidone treat ment. The results of the present study indicate that risperidone at doses o f 1 or 2 mg/day seems to be effective in reducing behavioral symptoms in pa tients with dementia. It is particularly active on agitation, aggression an d wandering. Risperidone also showed a good tolerability and had an efficac y either superior to the traditional neuroleptics or generally comparable, but with fewer side effects.