Psychopharmacology of Noncognitive Abnormal Behaviors in Alzheimer's Disease

Disruptive agitation and psychotic symptoms are important problems in the management of Alzheimer's disease and are major determinants of nursing home placement. This article reviews interpretable,placebo-controlled studies of psychopharmacologic approaches to the treatment of these"noncognitive" psychiatric and behavioral problems. Clinical trials of antipsychotic drugs demonstratemodest efficacy for psychosis and agitation, but adverse effects are common. Trials of serotoninselective reuptake inhibitors suggest they may be effective for emotional disturbances complicatingAlzheimer's disease. Trials of drugs that enhance central cholinergic activity (certain cholinesteraseinhibitors and selective M1 muscarinic cholinergic agonists) demonstrate positive effects on both cognitivedeficits and noncognitive psychiatric and behavioral problems. Further clinical studies areneeded to provide guidelines for the management of noncognitive psychiatric and behavioral problemsin Alzheimer's disease.