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Neuroleptic drugs in dementia: benefits and harm

Nature Reviews Neuroscience volume 7, pages 492–500 (2006)Cite this article

Abstract

Neuroleptic (antipsychotic) drugs are often used to treat psychiatric symptoms frequently seen in dementia, but their use is controversial. We present a new meta-analysis to assess the efficacy of these drugs for the treatment of psychiatric symptoms in Alzheimer's disease, and discuss the more limited evidence for their potential benefits in other dementias. We recommend that these treatments be limited to the short-term treatment of psychiatric symptoms associated with serious distress or risk.

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Acknowledgements

We would like to thank the Alzheimer Research Trust for supporting our programme of work examining the impact of neuroleptics in people with dementia, and the Cochrane review for the expertise and support for the new meta-analysis of atypical neuroleptics.

Author information

Authors and Affiliations

  1. the Medical Research Council Centre for Neurodegeneration Research, King's College London, De Crespigny Park, London, SE5 8AF, UK

    Clive Ballard & Robert Howard

  2. the Wolfson Centre for Age-Related Diseases, Wolfson Building, Guy's Campus, King's College London, London, SE1 1UL, UK

    Clive Ballard

  3. Director of Research for the Alzheimer's Society, UK

    Clive Ballard

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  1. Clive Ballard
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Corresponding author

Correspondence to Clive Ballard.

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Competing interests

C.B. has received research grants and honoraria from Janssen-Cilag, Eli Lilly, AstraZeneca, Lundbeck and Novartis. He has also received honoraria from Pfizer and Bristol-Myers Squibb.

R.H. has spoken at educational events sponsored by Janssen-Cilag and has acted as a paid consultant for Bristol-Myers Squibb.

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DATABASES

OMIM

Alzheimer's disease

Dementia with Lewy bodies

Frontotemporal dementia

FURTHER INFORMATION

The Cochrane Collaboration

Glossary

Study design Randomized controlled trial

Trial in which people are randomly assigned to an active treatment or matched placebo, with a double-blind design in which neither the doctors nor patients are aware of the treatment allocation.

Retrospective case-note review

Examining clinical case notes to obtain preliminary information about the effectiveness or side effects of treatments, or the outcome of symptoms. It is less reliable than a prospective study.

Criteria/scales Mini-mental state examination

(MMSE) Widely used cognitive assessment, scored out of 30 points, that was developed as a quick screening tool with which to identify people who may have dementia. It has been used widely in clinical trials, but is very insensitive to change.

Operationalized/standardized clinical criteria

The clinical diagnosis of a condition or key syndrome is based on a standardized set of criteria, with established rules and definition to enable consistent application. These are validated against a 'gold' standard, which for Alzheimer's disease is autopsy diagnosis.

Severe impairment battery

The only validated cognitive assessment for people with severe dementia, scored out of 140 points.

Standardized behavioural rating scale

A number of assessment scales have been developed to rate the presence and severity of neuropsychiatric symptoms in people with dementia. These are usually based on an interview with a caregiver.

Statistical terms Confidence intervals

A 95% confidence interval of an odds ratio indicates a 95% degree of certainty that the true odds ratio lies between these limits. It provides a way of estimating the degree of certainty about differences between experimental groups.

Effect size

For a comparison between an active drug and a placebo, this is calculated by subtracting the response to placebo from the response to active drug. Confidence intervals of this difference can then also be calculated.

Odds ratio

This compares the probability of an event in two groups. An odds ratio of >1 implies that the event is more likely in the first group. This is considered to be significant if both 95% confidence intervals are >1.

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Ballard, C., Howard, R. Neuroleptic drugs in dementia: benefits and harm. Nat Rev Neurosci 7, 492–500 (2006). https://doi.org/10.1038/nrn1926

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