Neuroleptics in the treatment of dementia

The authors review the history of neuroleptic treatment in dementia. The initial review of 34 studies published since 1954 was limited to the 20 double‐blind and / or placebo‐controlled studies. Sixty per cent of the studies revealed generally positive clinical results in demented patients following neuroleptic treatment. Acute side‐effects were not reported to be more prevalent or severe than in other psychiatric populations and included sedation, orthostatic hypotension, extrapyramidal reactions, and various anticholinergic symptoms. Careful assessment of the cognitive effects following neuroleptics, particularly those with known anticholinergic properties, was not performed in most of these studies and should be a focus of future prospective studies in this population. Nonetheless, it does appear that neuroleptics have a role in the treatment of patients with dementia. When used at low doses for specific purposes (i.e. treatment of agitation, hyperactivity, hallucinations, or hostility), they can both safe and effective in this population.