CNS Drugs

, Volume 6, Issue 4, pp 280–300 | Cite as

Behavioural Disorders in Demented Elderly Patients

Current Issues in Pharmacotherapy
  • Nathan Herrmann
  • Krista L. Lanctôt
  • Claudio A. Naranjo
Disease Management


Dementias are a significant cause of morbidity and mortality in developed countries. Although the key diagnostic factor that defines the dementias is a sustained loss of cognitive ability, dementias are also frequently accompanied by debilitating behavioural disturbances. These behavioural disturbances cause significant problems for the caregivers of people with dementia and are major factors precipitating institutionalisation.

The pathophysiological relationship between cognitive and behavioural disturbances has not been well studied. In Alzheimer’s disease, the major cause of dementia, behavioural problems can occur during all stages of cognitive impairment, from mild to severe. In vascular dementia, the second largest cause of dementia, behavioural problems are less predictable due to the variable course of this disease.

Following a differential diagnosis of the causes of behavioural disorders, nonpharmacological and pharmacological interventions may be required. Low dosages of antipsychotics remain the mainstay for treatment of these disturbances. Although there are no known differences in efficacy among the typical antipsychotics, careful consideration of the adverse effects of these drugs must be made on a case-per-case basis. The atypical antipsychotics clozapine and risperidone are currently being studied for this indication.

Non-antipsychotic medications such as β-blockers, lithium, benzodiazepines, antidepressants, anticonvulsants, buspirone and hormonal therapy have also been tried, with mixed results. Of these, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor antidepressants are the most promising treatments. The cognitive enhancer tacrine may be effective for the management of some behavioural disturbances, but this is still being evaluated.

Nonpharmacological interventions are often recommended prior to starting a medication. Behavioural management techniques are based on the systematic review and manipulation of antecedents and/or consequences of the target behaviour. A number of algorithms have been proposed for the management of behavioural disturbances, but, as yet, there are no evidence-based approaches available. However, current research is concentrating on the phenomenology and subtypes of behavioural disturbances.


Dementia Adis International Limited Clin Psychiatry Vascular Dementia Buspirone 
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  1. 1.
    Cross PS, Gurland GJ. The epidemiology of dementing disorders. Washington: Office of Technology Assessment, US Congress, 1986Google Scholar
  2. 2.
    Erkinjuntti T, Wikström J, Palo J, et al. Dementia among medical inpatients: evaluation of 2000 consecutive admissions. Arch Intern Med 1986; 146: 1923–6PubMedCrossRefGoogle Scholar
  3. 3.
    Ernst RL, Hay JW. The US economic and social costs of Alzheimer’s disease revisited. Am J Public Health 1994; 84: 1261–4PubMedCrossRefGoogle Scholar
  4. 4.
    Sapienza A. AD and related dementias: whose burden? Pharm News 1995; 2(1): 27–8Google Scholar
  5. 5.
    Eagles JM, Beattie JAG, Restall DB, et al. Relation between cognitive impairment and early death in the elderly. BMJ 1990; 300: 239–440PubMedCrossRefGoogle Scholar
  6. 6.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  7. 7.
    Civil RH, Whitehouse PJ, Lanska DJ, et al. Degenerative dementias. In: Whitehouse PJ, editor. Dementia. Philadelphia: F.A. Davis Company, 1993: 167–214Google Scholar
  8. 8.
    Yeager BF, Farnett LE, Ruzicka SA. Management of the behavioral manifestations of dementia. Arch Intern Med 1995 Feb 13; 155: 250–60PubMedCrossRefGoogle Scholar
  9. 9.
    DiMascio A, Shader RI. Behavioral toxicity. Part I: definition and Part II: psychomotor functions. In: Shader RI, Dimascio A, editors. Psychotropic drug side effects. Baltimore: The Williams and Wilkins Company, 1970: 124–48Google Scholar
  10. 10.
    Raskind MA. Geriatric psychopharmacology: management of late-life depression and the non-cognitive behavioral disturbances of Alzheimer’s disease. In: Dunner DL, editor. The psychiatric clinics of North America. Psychopharmacology II. Philadelphia: W.B. Saunders Company, 1993: 815–27Google Scholar
  11. 11.
    Cummings JL, Mega M, Gray K, et al. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44(12): 2308–14PubMedCrossRefGoogle Scholar
  12. 12.
    Reisberg B. Behavioral pathology in Alzheimer’s disease rating scale (BEHAVE-AD). J Clin Psychiatry 1987 May; 48Suppl.: 9–15PubMedGoogle Scholar
  13. 13.
    Cohen-Mansfield J, Billig N. Agitated behaviours in the elderly. I. A conceptual review. J Am Geriatr Soc 1986; 34: 711–21PubMedGoogle Scholar
  14. 14.
    Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol 1989; 44(3): M77–84PubMedCrossRefGoogle Scholar
  15. 15.
    Goldstein K. The after-effects of brain injuries in war: their evaluation and treatment. New York: Grune and Stratton, 1942Google Scholar
  16. 16.
    Rabins PV, Folstein MF. Delirium and dementia: diagnostic criteria and fatality rates. Br J Psychiatry 1982; 140: 149–53PubMedCrossRefGoogle Scholar
  17. 17.
    Reisberg B, Borenstein J, Salob SP, et al. Behavioral symptoms in Alzheimer’s disease: phenomenology and treatment. J Clin Psychiatry 1987; 48Suppl. 5: 9–15PubMedGoogle Scholar
  18. 18.
    Merriam AE, Aronson MK, Gaston P. The psychiatric symptoms of Alzheimer’s disease. J Am Geriatr Soc 1988; 36: 7–12PubMedGoogle Scholar
  19. 19.
    Teri L, Larson EB, Reifler BV. Behavioral disturbance in dementia of the Alzheimer’s type. J Am Geriatr Soc 1988; 36: 1–6PubMedGoogle Scholar
  20. 20.
    Wragg RE, Jeste DV. Overview of depression and psychosis in Alzheimer’s disease. Am J Psychiatry 1989; 146(5): 577–87PubMedGoogle Scholar
  21. 21.
    Eastwood MR. Abnormal behaviour associated with dementia. Int Psychiatry Today 1994; 4: 8–10Google Scholar
  22. 22.
    Reisberg B, Ferris SH, de Leon MJ, et al. Global deterioration scale (GDS). Psychopharmacol Bull 1988; 24: 661–3PubMedGoogle Scholar
  23. 23.
    Teri L, Rabins P, Whitehouse P, et al. Management of behaviour disturbance in Alzheimer disease: current knowledge and future direction. Alzheimer Dis Assoc Disord 1992; 6(2): 77–88PubMedCrossRefGoogle Scholar
  24. 24.
    Kunik ME, Yudofsky SC, Silver JM, et al. Pharmacologic approach to management of agitation associated with dementia. J Clin Psychiatry 1994; 55(2 Suppl.): 13–7PubMedGoogle Scholar
  25. 25.
    Whall AL, Gillis GL, Yankou D, et al. Disruptive behaviour in elderly nursing home residents: a survey of nursing staff. J Gerontol Nursing 1992 Oct; 12: 13–7Google Scholar
  26. 26.
    Zimmer JG, Watson N, Treat A. Behavioral problems among patients in skilled nursing facilities. Am J Public Health 1984; 74(10): 1118–21PubMedCrossRefGoogle Scholar
  27. 27.
    Swearer JM, Drachman DA, O’Donnell BF, et al. Troublesome and disruptive behaviours in dementia; relationship to diagnosis and disease severity. J Am Geriatr Soc 1988; 36(9): 784–90PubMedGoogle Scholar
  28. 28.
    Reisberg B. Memory dysfunction and dementia: diagnostic considerations. In: Salzman C, editor. Clinical geriatric psychopharmacology. 2nd ed. Baltimore: Williams & Wilkins, 1992: 255–76Google Scholar
  29. 29.
    Rubin EH, Kinscherf DA. Psychopathology of very mild dementia of the Alzheimer type. Am J Psychiatry 1989; 146: 1017–21PubMedGoogle Scholar
  30. 30.
    Sultzer DL, Levin HS, Mahler ME, et al. Assessment of cognitive, psychiatric, and behavioral disturbances in patients with dementia: the neurobehavioral rating scale. J Am Geriatr Soc 1992; 40: 549–55PubMedGoogle Scholar
  31. 31.
    Mega MS, Cummings JL, Foorello T, et al. The spectrum of behavioral changes in Alzheimer’s disease. Neurology 1996; 46(1): 130–5PubMedCrossRefGoogle Scholar
  32. 32.
    Sultzer DL, Levin HS, Mahler ME, et al. A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am J Psychiatry 1993; 150(12): 1806–12PubMedGoogle Scholar
  33. 33.
    Lopez OL, Becker JT, Brenner RP, et al. Alzheimer’s disease with delusions and hallucinations: neuropsychological and electroencephalographic correlates. Neurology 1991; 41: 906–12PubMedCrossRefGoogle Scholar
  34. 34.
    Förstl H, Burns A, Jacoby R, et al. Neuroanatomical correlates of clinical misidentification and misperception in senile dementia of the Alzheimer type. J Clin Psychiatry 1991; 52(6): 268–71PubMedGoogle Scholar
  35. 35.
    Kotrla KJ, Chacko RC, Harper RG, et al. SPECT findings on psychosis on Alzheimer’s disease. Am J Psychiatry 1995; 152: 1470–5PubMedGoogle Scholar
  36. 36.
    Starkstein SE, Vàsquez S, Petracca G, et al. A SPECT study of delusions in Alzheimer’s disease. Neurology 1994 Nov; 44: 2055–9PubMedCrossRefGoogle Scholar
  37. 37.
    Sultzer DL, Mahler ME, Mandelker MA, et al. The relationship between psychiatric symptoms and regional cortical metabolism in Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 1995; 7(4): 476–84PubMedGoogle Scholar
  38. 38.
    Zubenko GS, Moossy J, Martinez AJ, et al. Neuropathologic and neurochemical correlates of psychosis in primary dementia. Arch Neurol 1991; 48: 619–24PubMedCrossRefGoogle Scholar
  39. 39.
    Förstl H, Burns A, Luthert P, et al. Clinical and neuropathological correlates of depression in Alzheimer’s disease. Psychol Med 1992; 22: 877–84PubMedCrossRefGoogle Scholar
  40. 40.
    Zubenko GS, Moossy J. Major depression in primary dementia. Clinical and neuropathologic correlates. Arch Neurol 1988; 45: 1182–6PubMedCrossRefGoogle Scholar
  41. 41.
    Jaeschke R, Gyuyatt GH, Cook D. Quality of life instruments in the evaluation of new drugs. PharmacoEconomics 1992; 1(2): 84–94PubMedCrossRefGoogle Scholar
  42. 42.
    Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. JAMA 1982; 248: 333–5PubMedCrossRefGoogle Scholar
  43. 43.
    Gaspar D. Hollymoor hospital dementia service: analysis of outcome of 230 consecutive referrals to a psychiatric-hospital dementia service. Lancet 1980; I: 1402–5CrossRefGoogle Scholar
  44. 44.
    Petrie WM, Lawson EC, Hollender MH. Violence in geriatric patients. JAMA 1982; 248(4): 443–4PubMedCrossRefGoogle Scholar
  45. 45.
    Gleason RP, Schneider LS. Carbamazepine treatment of agitation in Alzheimer’s outpatients refractory to neuroleptics. J Clin Psychiatry 1990; 51 (3): 115–8Google Scholar
  46. 46.
    Ryden MB. Aggressive behaviour in persons with dementia who live in the community. Alzheimer Dis Assoc Disord 1988; 2(4): 342–55PubMedCrossRefGoogle Scholar
  47. 47.
    Cohen GD. Biopsychiatry in Alzheimer’s disease. In: Lawton MP, editor. Annual review of gerontology and geriatrics, vol 9. New York: Springer Verlag, 1989: 216–31Google Scholar
  48. 48.
    Howard K, Rockwood K. Quality of life in Alzheimer’s disease. Dementia 1995; 6: 113–6PubMedGoogle Scholar
  49. 49.
    Lawton M. Quality of life in Alzheimer’s disease. Alzheimer Disease Assoc Disord 1994; 8Suppl. 3: 138–50Google Scholar
  50. 50.
    Czobor P, Volavka J, Meibach RC. Effect of risperidone on hostility in schizophrenia. J Clin Psychopharmacol 1995; 15(4): 243–9PubMedCrossRefGoogle Scholar
  51. 51.
    Herrera JN, Sramek JJ, Costa JF, et al. High potency neuroleptics and violence in schizophrenics. J Nerv Ment Dis 1988; 176(9): 558–61PubMedCrossRefGoogle Scholar
  52. 52.
    Learoyd BM. Psychotropic drugs and the elderly patient. Med J Aust 1972; 1: 1131–3PubMedGoogle Scholar
  53. 53.
    Thapa PB, Meador KG, Gideon P, et al. Effects of antipsychotic withdrawal in elderly nursing home residents. J Am Geriatr Soc 1994; 42(3): 280–6PubMedGoogle Scholar
  54. 54.
    Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984; 141(11): 1356–64PubMedGoogle Scholar
  55. 55.
    Levin HS, High WM, Goethe KE, et al. The neurobehavioral rating scale: assessment of the behavioral sequelae of head injury by the clinician. J Neurol Neurosurg Psychiatry 1987; 50: 183–93PubMedCrossRefGoogle Scholar
  56. 56.
    Tariot PN, Mack JL, Patterson MB, et al. The behaviour rating scale for dementia of the consortium to establish a registry for Alzheimer’s disease. Am J Psychiatry 1995 Sep; 152: 1349–57PubMedGoogle Scholar
  57. 57.
    Cohen-Mansfield J. Agitated behaviours in the elderly. II. Preliminary results in the cognitively deteriorated. J Am Geriatr Soc 1986; 34: 722–7PubMedGoogle Scholar
  58. 58.
    Rosen J, Burgio L, Kollar M, et al. The Pittsburgh agitation scale - a user-friendly instrument for rating agitation in dementia patients. Am J Geriatr Psychiatry 1994; 2(1): 52–9PubMedCrossRefGoogle Scholar
  59. 59.
    Weiner MF, Koss E, Wild KV, et al. Measures of psychiatric symptoms in Alzheimer patients: a review. Alzheimer Dis Assoc Disord 1996; 10(1): 20–30PubMedGoogle Scholar
  60. 60.
    Schneider LS, Pollock VE, Lyness SA. A meta-analysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990; 38(5): 553–63PubMedGoogle Scholar
  61. 61.
    McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939–44PubMedCrossRefGoogle Scholar
  62. 62.
    Hachinski V, Iliff L, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975; 32: 632–7PubMedCrossRefGoogle Scholar
  63. 63.
    Hesse K, Driscoll A, Jacobson S. Neuroleptic prescriptions for acutely ill geriatric patients. Arch Intern Med 1993 Nov; 153: 2581–7PubMedCrossRefGoogle Scholar
  64. 64.
    Avorn J, Dreyer P, Connelly K, et al. Use of psychoactive medication and the quality of care in rest homes. Findings and policy implications of a state-wide study. N Engl J Med 1989; 320: 227–32PubMedCrossRefGoogle Scholar
  65. 65.
    Gurwitz JH, Sourerai SB, Avorn J. Improving medication prescribing and utilization in the nursing home. J Am Geriatr Soc 1990; 38(5): 542–52PubMedGoogle Scholar
  66. 66.
    Lantz MS, Louis A, Lowenstein G, et al. A longitudinal study of psychotropic prescriptions in a teaching nursing home. Am J Psychiatry 1990; 147(12): 1637–9PubMedGoogle Scholar
  67. 67.
    Semla TP, Palla K, Poddig B, et al. Effect of the Omnibus Reconciliation Act 1987 on antipsychotic prescribing in nursing home residents. J Am Geriatr Soc 1994; 42(6): 648–52PubMedGoogle Scholar
  68. 68.
    Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991; 151: 1825–32PubMedCrossRefGoogle Scholar
  69. 69.
    Helms PM. Efficacy of antipsychotics in the treatment of the behavioral complications of dementia: a review of the literature. J Am Geriatr Soc 1985; 33(3): 206–9PubMedGoogle Scholar
  70. 70.
    Sunderland T, Silver MA. Neuroleptics in the treatment of dementia. Int J Geriatr Psychiatry 1988; 3: 79–88CrossRefGoogle Scholar
  71. 71.
    Carlyle W, Ancill RJ, Sheldon L. Aggression in the demented patient: a double-blind study of loxapine versus haloperidol. Int Clin Psychopharmacol 1993; 8: 103–8PubMedCrossRefGoogle Scholar
  72. 72.
    Finkel SI, Lyons JS, Anderson RL, et al. A randomized, placebo-controlled trial of thiothixene in agitated, demented nursing home patients. Int J Geriatr Psychiatry 1995; 10: 129–36CrossRefGoogle Scholar
  73. 73.
    Raskind MA, Risse SC. Antipsychotic drugs and the elderly. J Clin Psychiatry 1986; 46(5 Suppl.): 17–22Google Scholar
  74. 74.
    Risse SC, Barnes R. Pharmacologic treatment of agitation associated with dementia. J Am Geriatr Soc 1986; 34: 368–76PubMedGoogle Scholar
  75. 75.
    Barnes R, Veith R, Okimoto J, et al. Efficacy of antipsychotic medications in behaviorally disturbed dementia patients. Am J Psychiatry 1982; 139: 1170–4PubMedGoogle Scholar
  76. 76.
    Lanctôt KL, Mittmann N, Liu BA, et al. Efficacy and safety of neuroleptics in behavioral disorders associated with dementia [abstract]. Clin Pharmacol Ther 1995; 57(2): 199Google Scholar
  77. 77.
    Sweet RA, Pollock BG, Mulsant BH, et al. Prolactin response to neuroleptic challenge in late-life psychosis. Psychopharmacol Bull 1995; 31(4): 651–7PubMedGoogle Scholar
  78. 78.
    Petrie WM, Ban TA, Berney S, et al. Loxapine in psychogeriatrics: a placebo- and standard-controlled clinical investigation. J Clin Psychopharmacol 1982; 2: 122–6PubMedCrossRefGoogle Scholar
  79. 79.
    Oberholzer AF, Hendriksen C, Monsch AU, et al. Safety and effectiveness of low-dose clozapine in psychogeriatric patients: a preliminary study. Int Psychogeriatr 1992; 4(2): 187–95PubMedCrossRefGoogle Scholar
  80. 80.
    Pitner JK, Mintzer JE, Pennypacker LC, et al. Efficacy and adverse effects of clozapine in four elderly psychotic patients. J Clin Psychiatry 1995; 56(5): 180–5PubMedGoogle Scholar
  81. 81.
    Ball CJ. The use of clozapine in older people. Int J Geriatr Psychiatry 1992; 7: 689–92CrossRefGoogle Scholar
  82. 82.
    Mertens C, Heylen SL. Risperidone in psychogeriatric patients with behavioral disturbances: an open long-term follow-up study. Report for trial RIS-BEL-13. Janssen Research Foundation, 1990 (Data on file)Google Scholar
  83. 83.
    Madhusoodanan S, Brenner R, Araujo L, et al. Efficacy of risperidone treatment for psychoses associated with schizophrenia, schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric patients: a case series. J Clin Psychiatry 1995; 56(11): 514–8PubMedGoogle Scholar
  84. 84.
    Yudofsky SC, Silver JM, Hales RE. Pharmacologic management of aggression in the elderly. J Clin Psychiatry 1990; 51(10 Suppl.): 22–8PubMedGoogle Scholar
  85. 85.
    Simpson GM, Pi EH, Sramek JJJ. Adverse effects of antipsychotic agents. Drugs 1981; 21: 138–51PubMedCrossRefGoogle Scholar
  86. 86.
    Zubenko GS, Lipinski JF, Cohen BM, et al. Comparison of metoprolol and propranolol in the treatment of akathisia. Psychiatry Res 1984; 11: 143–9PubMedCrossRefGoogle Scholar
  87. 87.
    Hayes PE, Schulz SC. The use of beta-adrenergic blocking agents in anxiety disorders and schizophrenia. Pharmacotherapy 1983; 3: 101–7PubMedGoogle Scholar
  88. 88.
    Yudofsky SC, Silver JM, Schneider SE. Pharmacologic treatment of aggression. Psychiatr Ann 1987; 27: 397–407Google Scholar
  89. 89.
    Petrie WM, Ban TA. Propranolol in organic agitation [letter]. Lancet 1981; I: 324CrossRefGoogle Scholar
  90. 90.
    Greendyke RM, Schuster DB, Wooton JA. Propranolol in the treatment of assaultive patients with organic brain disease. J Clin Psychopharmacol 1984; 4: 282–5PubMedCrossRefGoogle Scholar
  91. 91.
    Greendyke RM, Kanter DR, Schuster DB, et al. Propranolol treatment of assaultive patients with organic brain disease. J Nerv Ment Dis 1986; 174: 290–4PubMedCrossRefGoogle Scholar
  92. 92.
    Greendyke RM, Kanter DR. Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: a double-blind study. J Clin Psychiatry 1986; 47: 423–6PubMedGoogle Scholar
  93. 93.
    Greendyke RM, Berkner JP, Webster JC, et al. Treatment of behavioral problems with pindolol. Psychosomatics 1989; 30: 161–5PubMedCrossRefGoogle Scholar
  94. 94.
    Weiler PG, Mungas D, Bernick C. Propranolol for the control of disruptive behaviour in senile dementia. J Geriatr Psychiatr Neurol 1988; 1: 226–30CrossRefGoogle Scholar
  95. 95.
    Smith DA, Perry PJ. Non-neuroleptic treatment of disruptive behaviour in organic mental syndromes. Ann Pharmacother 1992; 26: 1400–8PubMedGoogle Scholar
  96. 96.
    Silver JM, Yudofosky SC, Kogan M, et al. Elevation of thioridazine plasma levels by propranolol. Am J Psychiatry 1986; 143: 1290–2PubMedGoogle Scholar
  97. 97.
    Weiler PG, Goodman TA. The use of propranolol in Alzheimer’s disease patients with disruptive behaviour. Curr Ther Res 1987; 42: 364–74Google Scholar
  98. 98.
    Ratey JJ, Sorgi P, O’Driscoll GA, et al. Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind placebo-controlled study. J Clin Psychiatry 1992; 53: 41–6PubMedGoogle Scholar
  99. 99.
    Sheard MH. Effect of lithium on human aggression. Nature 1971; 230: 113–4PubMedCrossRefGoogle Scholar
  100. 100.
    Schneider LS, Sobin PB. Non-neuroleptic medications in the management of agitation in Alzheimer’s disease and other dementia: a selective review. Int J Geriatr Psychiatry 1991; 6: 691–708CrossRefGoogle Scholar
  101. 101.
    Naranjo CA, Herrmann N, Mittmann N, et al. Recent advances in geriatric psychopharmacology. Drugs Aging 1995; 7: 84–202CrossRefGoogle Scholar
  102. 102.
    Wragg RE, Jeste DV. Neuroleptics and alternative treatments. Psychiatr Clin North Am 1988; 11: 195–213PubMedGoogle Scholar
  103. 103.
    Beber CR. Management of behaviour in the institutionalized aged. Dis Nerv Syst 1965; 26: 591–5PubMedGoogle Scholar
  104. 104.
    Chesrow EJ, Kaplitz SE, Vetra H, et al. Blind study of oxazepam in the management of geriatric patients with behavioral problems. Clin Med 1965; 72: 1001–5Google Scholar
  105. 105.
    Sanders JF. Evaluation of oxazepam and placebo in emotionally disturbed aged patients. Geriatrics 1965; 20: 739–46PubMedGoogle Scholar
  106. 106.
    Kirven LE, Montero EF. Comparison of thioridazine and diazepam in the control of non-psychotic symptoms associated with senility: double-blind study. J Am Geriatr Soc 1973; 21: 546–51PubMedGoogle Scholar
  107. 107.
    Covington JS. Alleviating agitation, apprehension, and related symptoms in geriatric patients: a double-blind comparison of a phenothiazine and a benzodiazepine. South Med J 1975; 68: 719–24PubMedCrossRefGoogle Scholar
  108. 108.
    Stotskey B. Multicenter study comparing thioridazine with diazepam and placebo in elderly non-psychotic patients with emotional and behavioral disorders. Clin Ther 1984; 6: 546–9Google Scholar
  109. 109.
    Coccaro EF, Kramer E, Zemishlany Z, et al. Pharmacologic treatment of non-cognitive behavioral disturbances in elderly demented patients. Am J Psychiatry 1990; 147: 1640–5PubMedGoogle Scholar
  110. 110.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980Google Scholar
  111. 111.
    Maletta GJ. Treatment of behavioral symptomatology of Alzheimer’s disease, with emphasis on aggression: current clinical approaches. Int Psychogeriatr 1992; 4 Suppl. 1: 117–30Google Scholar
  112. 112.
    Stern RG, Duffelmeyer ME, Zemeshlani Z, et al. The use of benzodiazepines in the management of behavioral symptoms in demented patients. Psychiatr Clin North Am 1991; 14: 375–84PubMedGoogle Scholar
  113. 113.
    Freinhar JP, Alvarez WA. Clonazepam treatment of organic brain syndromes in three elderly patients. J Clin Psychiatry 1986; 47: 525–6PubMedGoogle Scholar
  114. 114.
    Smeraski PJ. Clonazepam treatment of multi-infarct dementia. J Geriatr Psychiatry Neurol 1988; 1: 47–8PubMedCrossRefGoogle Scholar
  115. 115.
    Ginsburg ML. Clonazepam for agitated patients with Alzheimer’s disease. Can J Psychiatry 1991; 36: 237–8PubMedGoogle Scholar
  116. 116.
    Reifler BV, Teri L, Raskind M, et al. Double-blind trial of imipramine in Alzheimer’s disease patients with and without depression. Am J Psychiatry 1989; 146: 45–9PubMedGoogle Scholar
  117. 117.
    Peisah C, Brodaty H. Practical guidelines for the treatment of behavioral complications of dementia. Med J Aust 1994; 161: 558–63PubMedGoogle Scholar
  118. 118.
    Friedman R, Gryfe CI, Tal DT, et al. The noisy elderly patient: prevalence, assessment, and response to the antidepressant doxepin. J Geriatr Psychiatry Neurol 1992; 5: 187–91PubMedGoogle Scholar
  119. 119.
    Burke WJ, Folks DG, Roccaforte WH, et al. Serotonin reuptake inhibitors for the treatment of co-existing depression and psychosis in dementia of the Alzheimer’s type. Am J Geriatr Psychiatry 1994; 2: 352–4CrossRefGoogle Scholar
  120. 120.
    Reynolds CF, Perel JM, Kupfer DJ, et al. Open-trial to antidepressant treatment in elderly patients with mixed depression and cognitive impairment. Psychiatry Res 1987; 21: 111–22PubMedCrossRefGoogle Scholar
  121. 121.
    Jenike MA. Monamine oxidase inhibitors as treatment for depressed patients with primary degenerative dementia (Alzheimer’s disease). Am J Psychiatry 1985; 142: 763–4PubMedGoogle Scholar
  122. 122.
    Chan-Palay V. Depression and senile dementia of the Alzheimer’s type: a role for moclobemide. Psychopharmacology 1992; 106Suppl.: S137–9PubMedCrossRefGoogle Scholar
  123. 123.
    Aisen PS, Johannessen DJ, Marin DB. Trazodone for behavioral disturbances in Alzheimer’s disease. Am J Geriatr Psychiatry 1993; 1: 349–50CrossRefGoogle Scholar
  124. 124.
    Houlihan DJ, Mulsant BH, Sweet RA, et al. A naturalistic study of trazodone in the treatment of behavioral complications of dementia. Am J Geriatr Psychiatry 1994; 1: 78–85CrossRefGoogle Scholar
  125. 125.
    Lebert F, Pasquier F, Petit H. Behavioral effects of trazodone in Alzheimer’s disease. J Clin Psychiatry 1994; 55: 536–8PubMedGoogle Scholar
  126. 126.
    Tejera CA, Saravoy SM. Treatment of organic personality syndrome with low-dose trazodone. J Clin Psychiatry 1995; 56: 374–5PubMedGoogle Scholar
  127. 127.
    Lawlor BA, Radcliffe J, Molchan SE, et al. A pilot placebo-controlled study of trazodone and buspirone in Alzheimer’s disease. Int J Geriatr Psychiatry 1994; 9: 55–9CrossRefGoogle Scholar
  128. 128.
    Lebert F, Pasquier F, Petit H. Behavioral effects of fluoxetine in dementia of Alzheimer’s type. Int J Geriatr Psychiatry 1994; 9: 590–1CrossRefGoogle Scholar
  129. 129.
    Geldmacher DS, Waldman AJ, Doty L, et al. Fluoxetine in dementia of the Alzheimer’s type: prominent adverse effects and failure to improve cognition [letter]. J Clin Psychiatry 1994; 55: 161PubMedGoogle Scholar
  130. 130.
    Nyth AL, Gottfries CG. The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: a Nordic multicentre study. Br J Psychiatry 1990; 157: 894–901PubMedCrossRefGoogle Scholar
  131. 131.
    Olafsson K, Jorgensen S, Jensen HV, et al. Fluvoxamine in the treatment of demented elderly patients: a double-blind placebo-controlled study. Acta Psychiatr Scand 1992; 851: 453–6CrossRefGoogle Scholar
  132. 132.
    Sunderland T, Cohen RM, Molchan S, et al. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry 1994; 51: 607–15PubMedCrossRefGoogle Scholar
  133. 133.
    Martini E, Pataky I, Szelagyi K, et al. Brief information on an early phase II study with deprenyl in demented patients. Pharmacopsychiatry 1987; 20: 256–7PubMedCrossRefGoogle Scholar
  134. 134.
    Schneider LS, Gleason R, Zemansky MF, et al. A pilot study of low-dose L-deprenyl in Alzheimer’s disease. J Geriatr Psychiatry Neurol 1991; 4: 143–8PubMedCrossRefGoogle Scholar
  135. 135.
    Goad DL, Davis CM, Liem P, et al. The use of selegiline in Alzheimer’s patients with behaviour problems. J Clin Psychiatry 1991; 52: 342–5PubMedGoogle Scholar
  136. 136.
    Tariot PN, Cohen RM, Sunderland T, et al. L-Deprenyl in Alzheimer’s disease: preliminary evidence for behavioral change with monoamine oxidase B inhibition. Arch Gen Psychiatry 1987; 44: 427–33PubMedCrossRefGoogle Scholar
  137. 137.
    Mangoni A, Grassi MP, Frattola L, et al. Effects of a MAO-B inhibitor in the treatment of Alzheimer’s disease. Eur Neurol 1991; 31: 100–7PubMedCrossRefGoogle Scholar
  138. 138.
    Burke WJ, Roccaforte WH, Wengel SP, et al. L-deprenyl in the treatment of mild dementia of the Alzheimer type: results of a 15-month trial. J Am Geriatr Soc 1993; 41: 1219–25PubMedGoogle Scholar
  139. 139.
    Post RM, Susan R, Weiss B. Sensitization, kindling, and carbamazepine: an update on their implications for the course of affective illness. Pharmacopsychiatry 1992; 25: 41–3PubMedCrossRefGoogle Scholar
  140. 140.
    Leibovici A, Tariot PN. Carbamazepine treatment of agitation associated with dementia. J Geriatr Psychiatr Neurol 1988; 1: 110–2CrossRefGoogle Scholar
  141. 141.
    Patterson JF. Carbamazepine for assaultive patients with organic brain disease. Psychosomatics 1987; 28: 579–81PubMedCrossRefGoogle Scholar
  142. 142.
    Patterson JF. A preliminary study of carbamazepine in the treatment of assaultive patients with dementia. J Geriatr Psychiatr Neurol 1988; 1: 21–3CrossRefGoogle Scholar
  143. 143.
    Lemke MR. Effects of carbamazepine on agitation in Alzheimer’s inpatients refractory to neuroleptics. J Clin Psychiatry 1995; 56: 354–7PubMedGoogle Scholar
  144. 144.
    Chambers CA, Bain J, Rosbottom R, et al. Carbamazepine in senile dementia and overactivity - a placebo controlled double blind trial. Int Res Comm Sys Med Sci 1982; 10: 505–6Google Scholar
  145. 145.
    Tariot PN, Erb R, Leibovici A, et al. Carbamazepine treatment of agitation in nursing home patients with dementia: a preliminary study. J Am Geriatr Soc 1994; 42: 1160–6PubMedGoogle Scholar
  146. 146.
    Yudofsky SC, Silver JM, Jackson W, et al. The overt aggression scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986; 143: 35–9PubMedGoogle Scholar
  147. 147.
    Lefkowitz MM. Effects of diphenylhydantoin on disruptive behaviour. Arch Gen Psychiatry 1969; 20: 643–51PubMedCrossRefGoogle Scholar
  148. 148.
    Conners CK, Kramer R, Rothschild GH, et al. Treatment of young delinquent boys with diphenylhydantoin sodium and methylphenidate. Arch Gen Psychiatry 1971; 24: 156–60PubMedCrossRefGoogle Scholar
  149. 149.
    Mellow AM, Solano-Lopez C, Davis S. Sodium valproate in the treatment of behavioral disturbance in dementia. J Geriatr Psychiatry Neurol 1993; 6: 205–9PubMedGoogle Scholar
  150. 150.
    Sandborn WD, Bendfeldt F, Hamdy R. Valproic acid for physically aggressive behaviour in geriatric patients. Am J Geriatr Psychiatry 1995; 3: 239–42CrossRefGoogle Scholar
  151. 151.
    Sival RC, Haffmans PMJ, Van Gent PP, et al. The effects of sodium valproate on disturbed behaviour in dementia. J Am Geriatr Soc 1994; 42: 906–7PubMedGoogle Scholar
  152. 152.
    Mazure CM, Druss BG, Cellar JS. Valproate treatment of older psychotic patients with organic mental syndromes and behavioral dyscontrol. J Am Geriatr Soc 1992; 40: 914–6PubMedGoogle Scholar
  153. 153.
    Colenda CC. Buspirone in treatment of agitated demented patient [letter]. Lancet 1988; II: 1169CrossRefGoogle Scholar
  154. 154.
    Herrmann N, Eryavec G. Buspirone in the management of agitation and aggression associated with dementia. Am J Geriatr Psychiatry 1993; 1: 249–53CrossRefGoogle Scholar
  155. 155.
    Sakauye KM, Camp CJ, Ford PA. Effects of buspirone on agitation associated with dementia. Am J Geriatr Psychiatry 1993; 1: 82–4CrossRefGoogle Scholar
  156. 156.
    Levy MA, Burgio LD, Sweet R, et al. A trial of buspirone for the control of disruptive behaviours in community dwelling patients with dementia. Int J Geriatr Psychiatry 1994; 9: 841–8CrossRefGoogle Scholar
  157. 157.
    Bradford JMW. Organic treatments for the male sexual offender. Behav Sci Law 1985; 3: 355–75Google Scholar
  158. 158.
    Cooper AJ. Progestogens in the treatment of male sexual offenders: a review. Can J Psychiatry 1986; 31: 73–9PubMedGoogle Scholar
  159. 159.
    Cooper AJ. Medroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia. J Clin Psychiatry 1987; 48: 368–70PubMedGoogle Scholar
  160. 160.
    Kyomen HH, Nobel KW, Wei JY. The use of estrogen to decrease aggressive physical behaviour in elderly men with dementia. J Am Geriatr Soc 1991; 39: 1110–2PubMedGoogle Scholar
  161. 161.
    Nadal M, Allgulander S. Normalization of sexual behaviour in a female with dementia after treatment with cyproterone. Int J Geriatr Psychiatry 1993; 8: 265–7CrossRefGoogle Scholar
  162. 162.
    Rich SS, Ovsiew F. Leuprolide acetate for exhibitionism in Huntington’s disease. Mov Disord 1994; 9: 353–7PubMedCrossRefGoogle Scholar
  163. 163.
    Farlow M, Gracon SI, Hershey LA, et al. A controlled trial of tacrine in Alzheimer’s disease. JAMA 1992; 268: 2523–9PubMedCrossRefGoogle Scholar
  164. 164.
    Davis KL, Thai LJ, Gamzu ER, et al. A double-blind placebo-controlled multicentre study of tacrine for Alzheimer’s disease. N Engl J Med 1992; 327: 1253–9PubMedCrossRefGoogle Scholar
  165. 165.
    Knapp MJ, Knopman DS, Solomon PR, et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer’s disease. JAMA 1994; 271: 985–91PubMedCrossRefGoogle Scholar
  166. 166.
    Cummings JL, Gorman DG, Shapiro J. Physostigmine ameliorates the delusions of Alzheimer’s disease. Biol Psychiatry 1993; 33: 536–41PubMedCrossRefGoogle Scholar
  167. 167.
    Beck CK, Shue VM. Interventions for treating disruptive behaviour in demented elderly people. Nurs Clin North Am 1994; 29: 143–55PubMedGoogle Scholar
  168. 168.
    Rapp MS, Flint AJ, Herrmann N, et al. Behavioral disturbances in the demented elderly: phenomenology, and behavioral management. Can J Psychiatry 1992; 37: 651–7PubMedGoogle Scholar
  169. 169.
    Rewilak D. Behaviour management strategies. In: Rewilak D, Conn DK, Herrmann N, et al., editors. Practical psychiatry in the nursing home. Seattle: Hogrefe amp; Huber, 1992: 193–216Google Scholar
  170. 170.
    Nilsson K, Palmerstierna T, Wistedt B. Aggressive behaviour in hospitalized psychogeriatric patients. Acta Psychiatr Scand 1988; 78: 172–5PubMedCrossRefGoogle Scholar
  171. 171.
    Palmstierna T, Wistedt B. Staff observation aggression scale, SOAS. Presentation and evaluation. Acta Psychiatr Scand 1987; 76: 657–3PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • Nathan Herrmann
    • 1
    • 2
  • Krista L. Lanctôt
    • 3
    • 4
  • Claudio A. Naranjo
    • 1
    • 3
    • 4
    • 5
  1. 1.Department of Psychiatry, Sunnybrook Health Science CentreTorontoCanada
  2. 2.Division of Geriatric Psychiatry, Sunnybrook Health Science CentreTorontoCanada
  3. 3.Department of Pharmacology, Sunnybrook Health Science CentreTorontoCanada
  4. 4.Division of Psychopharmacology Research Program, Sunnybrook Health Science CentreTorontoCanada
  5. 5.Department of Medicine, Sunnybrook Health Science CentreTorontoCanada

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