[Diagnosis and therapy of behavior disorders in dementia]

Alzheimer's disease is one of the most common brain disorder in the elderly. In most patients who develop dementia the core syndrome of cognitive dysfunction is superimposed over the course of the disease by behavioral disorders that manifest at least temporarily to varying degrees. These include depression, anxiety, agitation, restlessness, aggression, disturbances of the sleep-wake cycle, delusions and hallucinations. Classical psychiatric exploration can be complemented by the use of the Neuropsychiatric Inventory (NPI) which allows structured diagnosis and comparative documentation of the clinical course. The majority of psychotropic drugs used in psychogeriatics have not been specifically developed for or tested in elderly, often multimorbid patients. Substances used in psychogeriatrics are subject to special requirements due to the pharmacokinetic and pharmacodynamic changes specific to very old persons. They must show clinical efficacy and a low rate of cardiovascular, peripheral and central anticholinergic effects, a low delirogenic potential and favorable pharmacokinetic and pharmacodynamic properties. Most of the newer atypical neuroleptics (e.g. risperidone) and the newer antidepressants (e.g. from the class of selective serotonin reuptake inhibitors, SSRIs, or selective serotonin and noradrenaline reuptake inhibitors, SNRIs) tend to fulfill these criteria better than the high-potency neuroleptics of the butyrophene type (e.g. haloperidol) or the tricyclic antidepressants. For that reason, these newer products should usually be preferred over the conventional agents.