Behavioral and psychological symptoms of
dementia (BPSD) are frequent amongst people with
Alzheimer's disease (AD) and other
dementias, commonly confer risk to that person and others, and present a significant management challenge for clinicians. There is increasing evidence to support the value of simple psychological interventions and the treatment of
pain as a first-line management strategy prior to
pharmacotherapy. The most widely prescribed pharmacological treatments-atypical
antipsychotics-have a modest but significant beneficial effect in the short-term treatment of aggression (over 6-12 weeks) but limited benefits in longer-term
therapy. In addition, there have been increasing concerns regarding the potential for serious adverse outcomes, including
stroke and death. The potential pharmacologic alternatives to atypical
antipsychotics with the most encouraging preliminary evidence include
memantine,
carbamazepine,
citalopram, and
prazosin. Large, prospective, randomized placebo-controlled trials are needed to establish the role of these agents as clinical
therapies for the treatment of BPSD.