DEMENTIA-BPSD PHARMACOLOGICAL MGM
SUMMARY
1. Cholinesterase inhibitors: Rivastigmine (better for Lewy body dementia), Donepezil, Galantamine. There is small but statistically significant evidence for these in BPSD. SE: brady-arrhythmias.
2. Antipsychotics: widely prescribed, moderate evidence. Avoid in Lewy body dementia & Parkinson's. Risperidone has been indicated for psychosis. FDA 2005 noted 1.6-1.7 increased risk of mortality.
3. Antidepressants: Citalopram (max dose 20 mg, risk of QTC prolongation, hyponatremia)[1]
, SSRI (meta-analysis showed insufficient evidence)
4. Mermantine: drug of choice for BPSD in advanced dementia. Well tolerated. SE: small number of patients become more agitated.
5. Carbamazepine
NB: only limited evidence for these. Figure out what behaviour you are treating first.
Reference(s)
- ↑ Citalopram for agitation in Alzheimer's disease study (CITAD)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
