Controversies in behavioral neurology: the use of atypical antipsychotic drugs to treat neurobehavioral symptoms in dementia.

"Atypical" antipsychotic drugs are widely used in patients with neurobehavioral disturbances related to dementia. Recent reports have highlighted the risks of these agents, including increased mortality, and the US Food and Drug Administration (FDA) has issued black-box warnings concerning their use. Studies of efficacy have shown only limited evidence that these drugs are more effective than placebo in controlling abnormal behaviors or improving the lives of patients with dementia and their caregivers. Recent evidence suggests that the older, "typical" antipsychotic drugs have at least as much risk as the atypical agents, and FDA warnings have been extended to these agents. In managing the behavioral disturbances of demented patients, clinicians must weigh the benefits and risks of these agents, use them only for severely disruptive behaviors, discontinue medications when ineffective, and inform families of the benefits and risks of treatment.