From the *Elderly Health Care, Ambulatory Center for Dementia, ASP Catanzaro; †Department of Science of Health, School of Medicine and Surgery, University "Magna Græcia" of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, and ‡Psychiatry Unit,"Mater Domini" University Hospital, Catanzaro, Italy.
J Clin Psychopharmacol. 2014 Feb;34(1):109-23. doi: 10.1097/JCP.0b013e3182a6096e.
In recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypical antipsychotics, adverse events, dementia, and behavioral and psychotic symptoms in dementia (BPSD). Owing to the large amounts of studies on antipsychotics, we mostly restricted the field of research to the last 10 years. Conventional antipsychotics have been widely used for BPSD; some studies showed they have an efficacy superior to placebo only at high doses, but they are associated with several and severe adverse effects. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, trials with risperidone and olanzapine in elderly patients affected with dementia-related psychoses suggested the possible increase in cerebrovascular adverse events. Drug regulatory agencies issued specific recommendations for underlining that treatment of BPSD with atypical antipsychotics is "off-label." Conventional antipsychotics showed the same likelihood to increase the risk of death in the elderly as atypical agents, and they should not replace the atypical agents discontinued by Food and Drug Administration warnings. Before prescribing an antipsychotic drug, the following are factors to be seriously considered: the presence of cardiovascular diseases, QTc interval on electrocardiogram, electrolytic imbalances, familiar history for torsades des pointes, concomitant treatments, and use of drugs able to lengthen QTc. Use of antipsychotics in dementia needs a careful case-by-case assessment, together with the possible drug-drug, drug-disease, and drug-food interactions.
近年来，由于抗精神病药物在老年痴呆症患者中的安全性问题备受争议，其应用受到了广泛的关注。为了更新老年痴呆症患者中抗精神病药物的使用情况，我们使用以下术语对 MEDLINE 进行了检索：老年人、传统和新型抗精神病药物、不良反应、痴呆、以及痴呆的行为和精神病性症状（BPSD）。由于大量关于抗精神病药物的研究，我们主要将研究领域限制在过去 10 年。传统抗精神病药物已广泛用于 BPSD；一些研究表明，只有高剂量时它们比安慰剂更有效，但它们与多种严重不良反应相关。新型抗精神病药物在 BPSD 治疗的随机研究中显示出优于安慰剂的疗效，与传统药物相比具有更好的耐受性。然而，在 2002 年，利培酮和奥氮平治疗与痴呆相关精神病的试验表明，可能会增加脑血管不良事件的风险。药物监管机构发布了具体建议，强调使用新型抗精神病药物治疗 BPSD 是“超适应证”的。传统抗精神病药物与新型抗精神病药物一样，增加老年人死亡的风险，不应替代因食品和药物管理局警告而停用的新型抗精神病药物。在开处方抗精神病药物之前，需要认真考虑以下因素：心血管疾病、心电图 QTc 间期、电解质失衡、尖端扭转型室性心动过速的家族史、伴随治疗以及使用可能延长 QTc 的药物。在痴呆症中使用抗精神病药物需要仔细的个体化评估，以及可能的药物-药物、药物-疾病和药物-食物相互作用。
