A Research Agenda for Disruptive Behaviors in Alzheimer's Disease: A Combined Biomedical and Behavioral Approach

Abstract

Disruptive behaviors have been reported in at least 50% of patients with Alzheimer's disease (AD) at some point during the course of their illness (Cummings et al., 1987). If patients with AD were carefully followed from the onset of illness through its terminal stages, the cumulative incidence of clinically significant disruptive behaviors would be even higher. Despite the paucity of data from well-designed studies evaluating the efficacy of management approaches to these disruptive behaviors, the prescription of antipsychotic medications (such as thioridazine and haloperidol) or antianxiety medications (such as benzodiazepines) to AD patients with disruptive behaviors is wide-spread, particularly in the long-term care setting (Harrington et al., 1992). The few interpretable placebo-controlled studies evaluating pharmacologic approaches to the management of disruptive behaviors have focused on anti-psychotic medications. Although these medications appear somewhat effective (approximately 20% greater than placebo response) (Barnes et al., 1982; Petrie et al., 1982; Schneider et al., 1990), their efficacy is much less than that observed in younger, nondemented patients with such major psychiatric diseases as schizophrenia. In addition, these medications often produce substantial motor and cognitive adverse effects that further minimize the variable and modest benefits of pharmacotherapy.