Pharmacologic treatment of noncognitive symptoms of dementia

Cognitive deterioration in dementia includes many changes besides memory disturbances, including agitation, delusions, hallucinations, anxiety, irritability, and aggressiveness. Antipsychotic drugs are often used to control behavioral symptoms, but their benefits are limited. Depression, which is common in dementia, is often associated with anxiety. Selective serotonin reuptake inhibitors (SSRIs) improve mood and reduce anxiety while causing few side effects; they are also useful in managing irritability. Thus, the SSRIs should be considered the agents of choice for treating noncognitive symptoms associated with dementia. Neuroleptics should be used exclusively in patients with severe behavioral or psychotic symptoms, and only those agents without anticholinergic effects should be administered. Neuroleptics can be coadministered with SSRIs in patients who are extremely aggressive. Anxiolytics may also be effective for shortterm use. Future studies of drugs to treat the noncognitive symptoms of dementia should be placebo controlled and should evaluate the effects of those drugs on cognitive function.