Aggression in the demented patient: a double-blind study of loxapine versus haloperidol

Aggression is common in dementia, with devastating social consequences. While high or low potency neuroleptics are the usual treatment of choice, they have been shown to yield inconsistent behavioral improvement and significant iatrogenic disability. This double-blind study was undertaken with aggressive demented patients to assess the efficacy and safety of a mid-potency neuroleptic, loxapine, in comparison to the more commonly prescribed high potency drug, haloperidol. Using an optimizing dosage regime, the outcome variables studied were aggression frequency and the number and nature of emergent side effects. Results demonstrated no significant difference regarding efficacy, but significantly fewer side effects with loxapine administration. The clinical and theoretical implications of these findings are discussed.