The use of novel antipsychotics in the older patient with neurodegenerative disorders in the long-term care setting.

Treating older patients with neurodegenerative disorders involves numerous challenges. The older patient population is expected to increase appreciably in the coming years; thus, there will be increasing numbers of these individuals requiring treatment. As a result, the appropriate choice of psychopharmacologic agents becomes an important decision in treating older patients with atypical antipsychotics. The atypical antipsychotic medications are replacing the high-potency conventional antipsychotics in the long-term care setting because of the lower risks of side effects. For instance, atypical antipsychotics have lower rates of extrapyramidal side effects and tardive dyskinesia. Double-blind placebo-controlled trials examining the use of risperidone and olanzapine have been published and indicate that both agents safely and effectively reduce agitation symptoms in long-term care patients with neurodegenerative disorders. For instance, based on these studies, the doses that appear efficacious in treating behavioral agitation in dementia are 0.5 to 1.5 mg per day of risperidone and 5 to 10 mg per day of olanzapine. In addition, there are open-label studies examining the use of quetiapine, which suggest that this agent is also safe and efficacious in patients with dementia. Doses used range approximately from 25 to 350 mg per day. Very few studies are available examining the newest atypical antipsychotics, ziprasidone and aripiprazole, in patients with neurodegenerative disorders. These studies do suggest that ziprasidone and aripiprazole are worth further study in the long-term care setting.