[Pharmacological management of delusions associated with dementia].

Abstract

This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia.

METHODS:

We searched PubMed using the words 'delusion', 'dementia' and 'treatment' from January 2007 till November 2017.

RESULTS:

Non-pharmacologic interventions are first-line treatment. Acetyl-cholinesterase inhibitors have shown conflicting results in the treatment of delusions in dementia patients. However, donepezil may be particularly useful in the treatment of psychotic symptoms in Lewy body dementia (LBD). Antipsychotics are reserved for the treatment of severe symptoms. The highest level of evidence exists for risperidone, followed by olanzapine and quetiapine. Clozapine and pimavenserine are therapeutic options for Parkinson disease dementia and LBD. The duration of antipsychotic treatment should not exceed 6 weeks as per the French recommendations (Agence nationale pour la sécurité du médicament) and 4 months as per the American psychiatric association recommendations. In the event of failure to respond to the aforementioned treatments or as an alternative, antidepressants, in particularly citalopram can be considered. There is not enough evidence to recommend melatonine for the treatment of delusions in dementia patients, although it has been shown to improve behavioral symptoms of dementia in general.

CONCLUSIONS:

The choice of medication for the treatment of delusions in dementia patients should be tailored to each patient. The severity of the symptom and its related danger should be considered along with the patient's co-morbidities and the medication's potential adverse effect.

• Authors: Sandra Abou Kassm, Wadih Naja, Nicolas Hoertel, Frédéric Limosin
• Journal: Geriatrie et psychologie neuropsychiatrie du vieillissement (Geriatr Psychol Neuropsychiatr Vieil) Vol. 17 Issue 3 Pg. 317-326 (09 01 2019) ISSN: 2115-7863 [Electronic] France
• Vernacular Title: Prise en charge pharmacologique des idées délirantes associées à un syndrome démentiel.
• PMID: 31449050 (Publication Type: Journal Article, Review)

Chemical References

• Antidepressive Agents
• Antipsychotic Agents
• Cholinesterase Inhibitors
• Psychotropic Drugs

Topics

• Aged
• Aged, 80 and over
• Antidepressive Agents (therapeutic use)
• Antipsychotic Agents (therapeutic use)
• Cholinesterase Inhibitors (therapeutic use)
• Delusions (drug therapy, etiology, psychology)
• Dementia (complications, drug therapy, psychology)
• Humans
• Psychotropic Drugs (adverse effects, therapeutic use)