Pharmacological treatment of non-cognitive disturbances in dementia disorders

Behavioral and psychological symptoms of dementia (BPSD) occur in 50-90% of patients with Alzheimer's disease (AD). They cause premature institutional ization, increased costs of care and significant loss of quality-of-life fo r the patient and his/her family and caregivers. Non-pharmacological interv entions are first-line in dealing with milder BPSD, while for moderate to s evere BPSD, medication is clearly indicated in conjunction with non-pharmac ological interventions. An imbalance of different neurotransmitters (acetyl choline, dopamine, noradrenaline, serotonin) has been proposed as the neuro chemical correlate of BPSD. An involvement of some specific brain regions r esponsible for emotional activities (parahippocampal gyrus, dorsal raphe, l ocus coeruleus) and cortical hypometabolism. have been suggested to contrib ute to BPSD. Atypical or novel antipsychotic drugs represent the reference drugs for treating BPSD. Among these, risperidone is considered as a drug o f choice. Also, selective serotonin reuptake inhibitors (SSRIs) are useful in the treatment of BPSD. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.