[Treatment of non cognitive symptoms of Alzheimer's disease]

Owing to their functional repercussions, the secondary or non-cognitive symptoms displayed by patients with Alzheimer's disease (AD) are very important both for the patients themselves and for the work of the caregiver. In this article we review the treatment of some of them, such as psychotic disorders and depressive symptoms. Atypical neuroleptic drugs are the preferred treatment for symptoms such as delusions, hallucinations, agitation and aggressive behaviour. The most widely used are olanzapine and risperidone. Their pharmacological characteristics, therapeutic effectiveness and side effects are reviewed.

Broader and better designed clinical studies are required to evaluate their usefulness. Recent reports, from 2004, have described a significant increase in the mortality rate (3.5 vs. 1.5%) and in the risk of suffering a stroke (1.3 vs. 0.4%) in elderly demented patients associated to the use of olanzapine and risperidone. The good tolerance and absence of anticholinergic effects of the serotonin reuptake inhibitors, fluoxetin and paroxetine, make them the first-choice medication for the treatment of the depressive symptoms in AD. Despite their widespread use, the evidence currently available with respect to their therapeutic effectiveness is not very convincing and clinical trials with a wider scope and a better design need to be carried out.