Atypical antipsychotics play a limited role in the management of dementia-related psychosis (DRP). Major adverse outcomes are associated with most antipsychotics in patients with dementia, and guidelines recommend that these drugs not be prescribed for long durations. When treating symptoms of DRP, clinicians should follow guidelines such as using medication only if the patient or others are in distress or danger and starting with low doses. Novel antipsychotics or alternative agents may offer superior efficacy and safety.
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Brexpiprazole for the Treatment of Agitation in Alzheimer's Disease Dementia: Clinical Uncertainties and the Path Forward.
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Department of Psychiatry, Oregon State Hospital, Adjunct Assistant Professor, Department of Neurology, Layton Aging and Alzheimer's Disease Research Center, Oregon Health and Science University, Mail Code CR131, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098. Electronic address:
Brexpirazole was approved for the treatment of nonpsychotic agitation in Alzheimer's disease (AD) dementia by the United States Food and Drug Administration (FDA) in May 2023 after three phase 3 clinical trials found brexpiprazole 2 to 3 mg/day to be an effective and well-tolerated treatment for agitation in AD dementia, albeit with small effect sizes. It appeared to especially benefit dementia patients with severe agitation/aggression, but it took between 6 and 12 weeks across the three studies for the medication to separate from placebo. However, much remains unknown about its place in the psychopharmacological armamentarium for the treatment of AD dementia-related agitation, including the optimal duration of a brexpiprazole trial, bridging options during the time it takes for brexpiprazole to become effective, and whether it should be continued in the presence of or upon emergence of psychosis during treatment.
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Article Synopsis
- The study investigates Alzheimer's disease-related psychosis (ADP) in older adults, focusing on demographic and clinical differences between those treated with antipsychotics and those who are not.
- Researchers analyzed data from over 145,000 ADP patients, comparing health outcomes related to falls, fractures, seizures, and mortality between the two groups.
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