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Clive Ballard Professor of Age Related Diseases, King s College London

Declaration of interest. I have received research grants from:Lundbeck, Novartis, Janssen-Cilag, Astra-Zeneca, AcadiaI have consultancy fees and/or honoraria in the last 5 years from from:Lundbeck, Novartis, Acadia Pfizer/Eisai, Bristol-Myer Squib. Structure of Presentation. Short-term prescribing with antipsychotics for Dementia*Efficacy associated with the antipsychoticsAdverse events associated with the antipsychoticsLong Term PrescribingEfficacy associated with the antipsychotics23

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Clive Ballard Professor of Age Related Diseases, King s College London

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    1. Clive Ballard Professor of Age Related Diseases, Kings College London

    2. Declaration of interest

    3. Structure of Presentation Short-term prescribing with antipsychotics for Dementia* Efficacy associated with the antipsychotics Adverse events associated with the antipsychotics Long Term Prescribing Efficacy associated with the antipsychotics Adverse events associated with the antipsychotics

    4. Up to 3 months

    5. Non AD dementias Vascular dementia (VaD) Some VaD patients in 2 of the risperidone studies. DLB/PDD only 1 RCT (with quetiapine), showing no significant benefit. Serious potential concerns re neuroleptic sensitivity Marked need for treatment studies examining treatment of neuropsychiatric symptoms in non-AD dementias, including trials of antipsychotics

    6. Risperidone Efficacy: BEHAVE-AD

    7. Schneider et al 2006 Aripiprazole

    10. STAR TRIAL: Zhong et al 2007

    11. Interim conclusion Risperidone* and Aripiprazole are effective in the short term treatment of aggression and possibly agitation

    12. Adverse events with Risperidone

    15. Mortality and antipsychotics in people with dementia

    16. Interim conclusion There are serious safety concerns with atypical antipsychotics, but the absolute risk with short term treatment is modest - eg mortality 1%.

    17. 6 12 months

    19. Clinical Antipsychotic Trials of Intervention EffectivenessAlzheimers Disease (CATIE-AD)

    20. CATIE: Discontinuation

    21. Responses to atypical antipsychotics

    22. Antipsychotic withdrawal studies Bridges-Parlet et al, 1997 Cohen-Mansfield et al, 1999 Ballard et al, 2002 RCT studies, 6 weeks3 months Total >180 participants No significant worsening of BPSD in any of the studies

    23. Change from Baseline to 6 months

    25. Change from Baseline to 6 months : Cognition

    26. Month 12 Outcome

    28. Differential Survival

    31. Conclusion For longer term treatment, the safety concerns outweigh the limited efficacy of antipsychotics for the treatment of BPSD However, atypical antipsychotics have the best evidence base for a pharmacological therapy for the short term treatment of aggression/agitation and therefore continue to play an important role in the short term treatment of agression/agitation in people with Alzheimers disease

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