Advancements in the treatment of agitation in Alzheimer's disease

• Published in: Expert opinion on pharmacotherapy Vol. 16; no. 11; p. 1649
• Main Authors: Antonsdottir, Inga M, Smith, Jessica, Keltz, Melanie, Porsteinsson, Anton P
• Format: Journal Article
• Language: English
• Published: England 01.08.2015
• Subjects: Alzheimer Disease - drug therapy; Alzheimer Disease - psychology; Cannabinoid Receptor Agonists - therapeutic use; Cannabinoids - therapeutic use; Citalopram - therapeutic use; Clinical Trials, Phase III as Topic; Dextromethorphan - therapeutic use; Drug Combinations; Humans; Psychomotor Agitation - drug therapy; Quinidine - therapeutic use; Randomized Controlled Trials as Topic; Serotonin Uptake Inhibitors - therapeutic use; Treatment Outcome; treatment; Alzheimer’s disease; dronabinol; pimavanserine; psychosocial intervention; agitation; behavioral and psychological symptoms of dementia; scyllo-inositol; cannabinoids; dementia; brexpiprazole; neuropsychiatric symptoms; citalopram; dextromethorphan/quinidine; prazosin
• ISSN: 1744-7666
• DOI: 10.1517/14656566.2015.1059422

Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are associated with significant negative outcomes for patients and their caregivers. Agitation, one of the most distressing NPS, lacks well-established long-term interventions that are both effective and safe. While non-pharmacological interventions are the suggested first-line treatment, it isn't effective in managing symptoms for every patient. In such cases, clinicians turn to the use of pharmacological interventions. Traditionally, these interventions consist of off-label use of antipsychotics, sedative/hypnotics, anxiolytics, acetylcholinesterase inhibitors, memantine and antidepressants, where the efficacy doesn't necessarily outweigh the associated risks. Gains made in understanding the neurobiological mechanisms underlying agitation have fueled several recent clinical trials. A comprehensive literature search for published articles evaluating pharmacologic interventions for agitation in AD was done. A review of some of these clinical trials was completed: dextromethorphan/quinidine, scyllo-inositol, brexpiprazole, prazosin, cannabinoids, dronabinol and citalopram show promise in treating agitation. Neurobiological findings and enhanced trial designs have re-ignited the area of pharmacological treatment of NPS. Although further research is needed to fully determine the safety, tolerability and efficacy of these treatments, the mission to finding effective treatments for NPS such as agitation in patients with dementia is well underway.