Psychosis and behavioural symptoms of dementia: defining the role of neuroleptic interventions

Neuroleptics have a definite role in dementia but the treatment targets need to be more narrowly defined. Symptom clusters that are neuroleptic-responsive (e.g., aggression, psychomotor agitation and psychosis) appear to be emerging but need clearer definition and measurement. A number of these symptom clusters are relatively persistent over time and associated with increased risk of institutionalization, underscoring the need for treatment. The frequency, severity and persistence of the symptom or behaviour, the context in which it occurs and its impact on the carer must be considered before prescribing a neuroleptic. Given the modest effect size for neuroleptic interventions, the safety and tolerability of the agent is also a key factor in determining drug choice. Novel neuroleptics are safer and better tolerated and therefore should be used in preference to conventional agents when neuroleptic treatment is indicated for behavioural and psychological symptoms of dementia.