Demenzerkrankungen - Behandlung von Verhaltensstörungen mit Neuroleptika

Alzheimer's disease and associated disorders are characterized by a high prevalence of severe psychological symptoms. Behavioural disturbances complicate the disease course and significantly impact patients' and caregivers' condition. Second generation antipsychotics (SGA) have been shown in several well-designed trials to be moderately effective in treating severe behavioural pathology and psychotic symptoms. These results are contrasted by increased risk for cerebrovascular events and mortality. Hazards may be alleviated by individual choice of SGA, that consider existing co-morbidities and common polypharmacy in the elderly. Making the decision for a treatment with SGA in dementia should rather be individualized by agreement with the relatives and the patient himself, if possible instead of exlusively relying on clinical trial evidence. Early application of acetylcholinesterase inhibitors may exert positive long-term influence on psychopathology and thus contribute to alleviate the problematic issue of behavioural disturbances.