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Medication Reduces Aggression and Agitation in Patients with Severe Dementia
ST. PAUL, MN -- Patients with dementia face not only life-altering changes in mental abilities, but also changes in behavior that can lead to aggression and agitation. Kicking, swearing or biting, the violent behaviors associated with the late stages of dementia, may improve with a new medication, according to a study in the September 22 issue of Neurology, the scientific journal of the American Academy of Neurology.
Researchers suggest that risperidone can reduce the severity and frequency of aggressive and agitated behaviors in elderly people with dementia.
"It's important for people, especially caregivers, to know that violent behaviors can be treated," said neurologist and study author Peter De Deyn, MD, of the University of Antwerp in Belgium. "Nearly 80 percent of people in the late stages of dementia develop violent behaviors. Risperidone can improve the quality of life for these patients and their caregivers."
In a 13-week study of 223 people in seven European countries and Canada, researchers investigated risperidone as a treatment for the behavioral symptoms of dementia. Researchers compared the effects risperidone to the drug haloperidol (another medication used to treat aggressive symptoms of dementia) and a placebo in people with frequent aggressive behaviors associated with the late stages of dementia.
Study participants, an average age of 81, lived in nursing homes. Sixty-seven percent of people in the study had dementia related to Alzheimer's disease, 26 percent had vascular dementia and the remaining patients had other types of dementia.
Researchers gave one-third of the study participants risperidone, one-third haloperidol and one-third a placebo. Each person's health, severity of dementia and frequency of aggressive behaviors were evaluated prior to and during the study.
The severity of aggression was improved by two to four times more in people taking risperidone than those taking a placebo. The number of physical or verbally aggressive episodes improved by 34 percent for people taking risperidone as compared to 8 percent of people taking the placebo. "Our results suggest that risperidone caused not only an anti-psychotic effect, but also an anti-aggressive effect," said De Deyn.
People on haloperidol also showed an improvement in aggressive behaviors which was 20 percent greater than those taking the placebo. In comparing the two medications, risperidone had up to a 40 percent greater improvement on aggressive behaviors than haloperidol.
Researchers also suggest risperidone is more tolerable in elderly patients than haloperidol. "Haloperidol can cause some people to experience muscle stiffness and tremors similar to Parkinson's disease," said De Deyn.
Medications causing drowsiness may appear to improve aggression. Researchers determined that haloperidol and risperidone caused some drowsiness, but overall it did not affect study results.
After the study was in progress, 121 people dropped out of the original study group of 344 people. The study was completed by 223 people. The most common reasons patients gave for dropping out of the study were side effects and lack of effectiveness. The dropouts came equally from the risperidone, haloperidol and placebo groups.
"A dementia patient's violent behaviors may underlie a caregiver's decision to place their loved one in a nursing home," said De Deyn. "As the world's population ages, there may be more people with dementia. To manage the personal and societal costs associated with having more dementia patients in nursing homes, it's essential that we find better ways to care for patients with dementia."
The American Academy of Neurology, an association of more than 16,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.
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