From the Research
For dementia with psychotic disturbance, risperidone is the preferred antipsychotic due to its efficacy in reducing agitation and psychosis with a relatively favorable side effect profile, as evidenced by a 2021 Cochrane review 1. When considering injectable antipsychotics, it's crucial to weigh the benefits against the risks, particularly the increased risk of extrapyramidal side effects and mortality in elderly patients with dementia.
- The most recent and highest quality study, a 2021 Cochrane review 1, found that atypical antipsychotics like risperidone probably reduce agitation slightly and have a negligible effect on psychosis, but increase the risk of somnolence and other adverse events.
- Risperidone has been shown to be effective in managing behavioral and psychological symptoms of dementia, with a relatively low risk of extrapyramidal symptoms compared to typical antipsychotics like haloperidol 2.
- Non-pharmacological approaches should be tried first, including identifying and addressing triggers for behavioral disturbances, maintaining routine, and creating a calm environment.
- When medication is necessary, regular reassessment is essential to determine if continued treatment is needed, with attempts to taper and discontinue when possible.
- The use of antipsychotics in dementia patients should always be preceded by an accurate clinical diagnosis, as recommended by a 2004 study 3.
- Other studies, such as a 2011 pilot study 4 and a 2008 expert opinion 5, also support the use of risperidone for dementia-associated psychosis, but the 2021 Cochrane review 1 provides the most comprehensive and up-to-date evidence.