Which drugs are best when aggressive Alzheimer's patients need medication?

Abstract

Atypical antipsychotics are an effective short-term (6-12 weeks) treatment for aggressive behavior in patients with Alzheimer's disease because they consistently decrease aggression scores (strength of recommendation [SOR]: A, multiple randomized controlled trials [RCTs]). However, evidence of drug-related deaths in patients taking these drugs mandates weighing the benefits against the risks. SSRIs may be a safer, effective alternative (SOR: B, limited studies). Evidence for the efficacy of antiepileptic agents is conflicting (SOR: C, inconsistent patient-oriented evidence). Valproate is ineffective for treating aggression (SOR: C, very small RCT). No data exist to guide long-term medication use. All available studies lasted no longer than 12 weeks. Nonpharmacologic therapy should be the first-line treatment for aggression in patients with Alzheimer's disease. Consider drug therapy for patients who pose an imminent threat to themselves or others.