Cholinesterase Inhibitors May Reduce Need for Antipsychotics in Dementia

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March 6, 2007 (New Orleans) — Cholinesterase inhibitors may be useful in the management of behavioral and psychological symptoms of dementia (BPSD), according to a study presented here at the annual meeting of the American Association for Geriatric Psychiatry.

BPSD, which includes symptoms such as depression, anxiety, delusions, and agitation, is currently treated with psychotropic medications including antipsychotics, antidepressants, and hypnotics. Atypical antipsychotics such as cholinesterase inhibitors, which prevent the breakdown of the neurotransmitter acetylcholine, may have a role to play in the management of BPSD patients, enabling those who are taking other psychotropic medications to reduce their dose or stop taking them completely. Cholinesterase inhibitors include donezipil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne).

"This was a retrospective chart study," said Mohd Shamsi, MD, a resident in psychiatry at the University of Missouri in Columbia, who compared 2 local groups of patients diagnosed with dementia. One group (n = 62) was taking cholinesterase inhibitors, while the other group (n = 62) was not. "We looked at the number of patients in each of the 2 groups taking psychotropic drugs," he said.

According to Dr. Shamsi, patients with dementia were more than twice as likely to have a prescription for a psychotropic if they were not receiving a cholinesterase inhibitor (odds ratio, 2.685; P = .007).

Thirty-eight patients (61.3%) in the cholinesterase inhibitor group were not taking other psychotropics, while 39 patients (62.9%) not on cholinesterase inhibitors were taking other psychotropics. This initial study did not examine doses, compliance issues, or severity of symptoms, nor did it examine specific psychotropics other than cholinesterase inhibitors. "This was a very limited snapshot study," Dr. Shamsi said.

Lon Schneider, MD, a professor of psychiatry at the Keck School of Medicine in Los Angeles, California, told Medscape, "This was a small initial study. However, other studies have shown that atypical antipsychotics are in some cases no more effective than placebos in controlling dementia; these other trials provided no evidence supporting their use for these patients."

The efficacy of cholinesterase inhibitors in treating dementia continues to be an area of active debate among clinicians and researchers. Further exploration of whether they actually reduce the need for psychotropic medications in managing BPSD is needed, Dr. Schneider said.

The study did not receive any commercial support. The study author and Dr. Schneider report no relevant financial relationships.

AAGP 2007 Annual Meeting: Abstract 49. Presented March 3, 2007.

Source: http://www.medscape.com/viewarticle/553183?src=mp