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Alternative pharmacological treatment options for agitation in Alzheimer’s disease

Francesco Panza, Vincenzo Solfrizzi, Bruno P. Imbimbo, Andrea Santamato, Madia Lozupone, Giancarlo Logroscino
  • Francesco Panza
    Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari; Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase (LE), Italy | geriat.dot@geriatria.uniba.it
  • Vincenzo Solfrizzi
    Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
  • Bruno P. Imbimbo
    Research & Development Department, Chiesi Farmaceutici, Parma, Italy
  • Andrea Santamato
    Physical Medicine and Rehabilitation Section, University Hospital of Foggia, Foggia, Italy
  • Madia Lozupone
    Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
  • Giancarlo Logroscino
    Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari; Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase (LE), Italy

Abstract

In patients with dementia and Alzheimer’s disease (AD), treatment of neuropsychiatric symptoms (NPS) is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs), with disappointing results. However, evidence coming from recently completed RCTs on novel or repositioned drugs (mibampator, dextromethorphan/ quinidine, cannabinoids, and citalopram) showed some promise in treating agitation in AD, but still with safety concerns. Further evidence will come from ongoing Phase II and III trials on promising novel drugs for treating these distressing symptoms in patients with AD and dementia.

Keywords

Agitation; aggression; Alzheimer’s disease; dementia; antipsychotics; antidepressants.

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Submitted: 2015-07-28 01:44:11
Published: 2015-11-24 13:50:00
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Copyright (c) 2015 Francesco Panza, Vincenzo Solfrizzi, Bruno P. Imbimbo, Andrea Santamato, Madia Lozupone, Giancarlo Logroscino

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