Fast Five Quiz: Test Your Knowledge on Key Aspects of Alzheimer's Disease

Amy Kao, MD; Helmi L. Lutsep, MD; Aimee L. Pierce, MD

Disclosures

January 19, 2021

Antidepressants have an important role in the treatment of mood disorders in patients with Alzheimer's disease. According to some studies, depression is present in up to 50% of patients with Alzheimer's disease, the onset of which typically occurs prior to the clinical diagnosis of Alzheimer's disease. Therefore, palliation of this frequent comorbid condition may improve cognitive and noncognitive performance.

No specific agent or dose of individual agents is unanimously accepted for the wide array of clinical manifestations associated with depression. At present, the US Food and Drug Administration has not approved any psychotropic agent for the treatment of Alzheimer's disease.

In 2005, the FDA added a black box warning on the use of all atypical (second-generation) antipsychotic agents in the treatment of secondary symptoms of Alzheimer's disease, such as agitated or aggressive behavior. This decision was based on analyses suggesting that patients on atypical neuroleptics had increased risk for death or stroke compared with patients on placebo. For the same reason, in 2008, the black box warning was extended to include all typical (first-generation) antipsychotics, including chlorpromazine, haloperidol, prochlorperazine, and thioridazine. The general recommendation is to use such agents as infrequently as possible and at the lowest doses possible to minimize adverse effects, particularly in frail, elderly patients.

Results of several studies indicate that anticonvulsants (eg, gabapentin, valproic acid) may have a role in the treatment of behavioral problems in patients with Alzheimer's disease. However, a trial of 313 patients with moderate Alzheimer's disease found that 24 months of treatment with valproate did not delay emergence of agitation or psychosis, did not slow cognitive or functional decline, and was associated with significant toxic effects.

Learn more about the treatment of Alzheimer's disease.

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