Behavioural symptoms—such as psychosis, agitation, depression, and wandering—are common and impose tremendous strain on caregivers. Diagnosis is challenging because of the lack of biological markers, insidious onset, and need to exclude other causes of dementia. (Mental Health, 1)
Dementia is a prominent healthcare issue for primary care physicians and specialist services. Over 90% of patients with dementia experience a “behaviour disturbance,” often referred to as behavioural or psychological signs in dementia in accordance with the recommendation of the International Psycho geriatric Association. These symptoms are distressing to patients and troublesome to carers and often precipitate admission to residential facilities. What is the evidence that any of the several drugs that are currently used to treat these symptoms are effective?
Managing the behavioural and psychological signs of dementia is a major problem for healthcare professionals. Narcoleptic drugs are the mainstay of pharmacological treatment, although their use is justified largely on the basis of clinical anecdote, and they have many harmful side effects. These include Parkinsonism, drowsiness, tardive dyskinesia, falls, accelerated cognitive decline, and severe narcoleptic sensitivity reactions. It is therefore not surprising that the chief medical officer has recommended judicious use of these agents in patients with dementia.
In 1990 Schneider published a landmark study showing the paucity of large, placebo controlled, double blind trials of narcoleptic agents in treating behavioural and psychological signs in dementia. Since then research in the subject has increased, but most treatment studies have used an open or active comparison design, a major methodological flaw given the high placebo response rates (40%). Two large multi-centre studies with