Behavioral symptoms start to appear in mild and moderate
dementia and become increasingly severe with the progression of the disease. Agitation, aggressiveness, and
psychosis can be seen in
Alzheimer's disease, and in particular are common manifestations in
Lewy body dementia. It is the behavioral disturbances rather than the
cognitive disorders that are more often the cause of the
institutionalization of these patients because of the heavy assistance and emotional burden they represent for caregivers. Traditionally, these kinds of symptoms were controlled by classical
antipsychotic agents, which after long-term use cause severe extrapyramidal effects, late
dyskinesia, sedation,
orthostatic hypotension, and cognitive function impairment. More recently, atypical
antipsychotic agents have shown a better tolerability profile, with a reduced incidence of extrapyramidal effects,
orthostatic hypotension, sedation, and a reduced impact on cognitive function. The aim of this study is to evaluate the efficacy and tolerability of
quetiapine in a group of patients with a diagnosis of
dementia and concomitant
psychotic disorders. The response to treatment was evaluated by the Neuropsychiatric Inventory (NPI) and the Behavioral Pathology in
Alzheimer's Disease Rating Scale (BEHAVE-AD). The NPI and BEHAVE-AD were administered at baseline and after 4 weeks and 12 weeks of
therapy. Tolerability was assessed by the incidence of clinically evident side effects. The results show that
quetiapine is effective in reducing behavioral symptoms, deliria and
hallucinations, aggressiveness, and sleep disturbances.
Quetiapine tolerability proved to be satisfactory. The only side effect of clinical significance was
orthostatic hypotension, which was, however, partially preventable by a slower
drug titration.