["Judicious" use of neuroleptic drugs in the treatment of behavioral symptoms in the course of Alzheimer disease].

It is estimated that about one-half of Alzheimer's patients develop psychotic and/or behavioural signs and symptoms which can cause the most distress and difficulties to families and healthcare professionals. The prevalence and the type of problem behaviours varies remarkably with the course of Alzheimer's disease, the severity of cognitive impairment, the neuropathology and biochemical changes. The prevalence varies also in relation to the setting, sample size, rating instruments for assessment, comorbidity, coexistence of different problem behaviours and pharmacological therapies. Neuroleptics are the only documented pharmacological treatment for psychosis, agitation, suspicion, delusions and hallucinations. Neuroleptics have a number of potentially severe adverse effects, that caution against their widespread use in elderly patients. High potency agents such as haloperidol are more likely to cause Parkinsonian symptoms, while low-potency agents such as thioridazine and chlorpromazine are more likely to cause sedation, confusion, delirium, postural hypotension and peripheral anticholinergic effects. The new antipsychotic agents (atypical neuroleptics) such as risperidone, clozapine and olanzapine appear to have efficacy either superior to the traditional neuroleptics or are generally comparable with fewer side-effects. These results however refer to clinical studies in patients with schizophrenia and they have not yet been tested with demented population in well controlled trials.