Ziprasidone for dementia in elderly patients: case review

Treatment of elderly patients with dementia-related behavioral disturbances and depression-related psychosis poses a significant problem, considering patients' frailty and use of polypharmacy for comorbid medical disorders. This case series describes the use of ziprasidone, a novel atypical antipsychotic, in three frail, elderly patients admitted to the hospital for behavioral disturbances secondary to dementia-related illness after their current treatment failed to improve symptoms or produced intolerable side effects. At admission, none of the patients were taking medications contraindicated for use with ziprasidone. In each case, ziprasidone resolved symptoms of agitation, psychosis, depression, and cognitive impairment sufficiently to permit discharge on maintenance therapy to assisted-living facilities or nursing homes. No patient suffered syncope or postural hypotension during treatment with ziprasidone. Electrocardiograms taken on admission and after institution of ziprasidone disclosed minimal increases in the QTc interval or no change from baseline, and no patient had a QTc interval > 500 ms. No drug-drug interactions occurred. Similar results were observed in an additional 53 of 62 elderly patients (aged 64-92 years) admitted to our institution. This experience suggests that ziprasidone is a safe and effective treatment option in elderly individuals who require antipsychotic medication.