Alzheimer’s Disease update (2007)

by Fred Lane PhD

A promising intervention for one important aspect of Alzheimer’s disease has foundered, once more, in the same manner that so many Alzheimer’s treatment proposals fail to live up to their early promise. Insulated from drug company influences, recent studies of a class of drugs called the atypical antipsychotics, such as Zyprexa (olanzipine), Seroquel (quetiapine) and Risperdal (risperadone), proved them to be not only no better than placebos and earlier cheaper drugs, but also more likely to cause death (Schneider et al, 2006).

The authors note that these atypical antipsychotics “are widely used to treat psychosis, aggression, and agitation in patients with Alzheimer’s disease,” and are touted to be a major improvement on existing drugs. The new drugs were expensive and not FDA-approved for Alzheimer’s disease, but they were commonly prescribed “off label” to control aggression and agitation, especially in nursing homes.

Double-blind placebo-controlled cross-over

The Schneider et al experiments employed a convincing double-blind placebo cross-over controlled design involving 421 outpatients in 42 sites across 19 American states. They were looking specifically for changes in hallucinations (seeing or hearing things), delusions (false beliefs) and agitation. The main intervention ran for 12 weeks with a 36-week followup test.

The 1950s-era antipsychotic drugs, such as Haldol (haloperidol), Stelazine (trifluoperazine) and Largactil (chlorpromazine), were effective in controlling aggression and agitation in maybe a quarter of all schizophrenia patients and they helped a smaller proportion of aggressive elderly dementia patients. Unfortunately, they also had severe side effects with many patients, ranging from non-compliance to sedation, confusion and tardive dyskenesia.

Nowadays, the atypical anti-psychotics sold in the USA carry prominent warnings about the increased likelihood of death and other side effects.

Reference:

Schneider L.S., Tariot P.N., Dagerman K.S., et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. New England Journal of Medicine. 355/15, 12 October 2006, pp 1525-1538.