Behavioral and Psychological Symptoms in Patients With Dementia as a Target for Pharmacotherapy With Risperidone

Jonathan Rabinowitz, Ph.D.; Ira R. Katz, M.D., Ph.D.;Peter Paul De Deyn, M.D., Ph.D., M.M.P.R.;Henry Brodaty, B.S., M.D., F.R.A.C.P., F.R.A.N.Z.C.P.;Andrew Greenspan, M.D.; and Michael Davidson, M.D.

Objective: To examine the effect of risperidone on specific behavioral and psychological symptoms of dementia (BPSD).

Method: We conducted a post hoc exploratory analysis of an integrated database from 3 randomized, controlled trials of risperidone versus placebo in treating 1150 nursing home residents with BPSD. Changes in scores were measured for items on the Cohen-Mansfield Agitation Inventory (CMAI) and Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD).

Results: On the CMAI, risperidone was significantly more effective in treating hitting (p = .000), hurt self or other (p = .005), cursing or verbal aggression (p = .000), repetitive sentences or questions (p = .001), scratching (p = .041), general restlessness (p = .001), grabbing onto people (p = .028), constant request for attention (p = .041), pacing and aimless wandering (p = .013), and performing repetitious mannerisms (p = .045). On the BEHAVE-AD, risperidone was significantly more effective in treating physical threats and/or violence (p = .000), verbal outbursts (p = .000), other anxieties (p = .01), agitation (p = .000), tearfulness (p = .03), and nonparanoid delusions (p = .02).

Conclusions: The items from the BEHAVE-AD and CMAI that were improved with risperidone included psychotic, agitated, and aggressive symptoms. These data suggest that risperidone is more effective than placebo in treating a variety of symptoms associated with dementia.

(J Clin Psychiatry 2004;65:1329-1334)

Received Feb. 19, 2004; accepted July 20, 2004. From Bar Ilan University, Ramat Gan, Israel (Dr. Rabinowitz); the University of Pennsylvania Medical School, Philadelphia (Dr. Katz); General Hospital Middelheim, University of Antwerp, Antwerp, Belgium (Dr. De Deyn); Academic Department for Old Age Psychiatry, University of New South Wales, Sydney, Australia (Dr. Brodaty); Janssen Pharmaceutica Products, L.P., Titusville, N.J. (Dr. Greenspan); and Tel Aviv University, Tel Aviv, Israel (Dr. Davidson).

The authors acknowledge Janssen Pharmaceutica (Beerse, Belgium), who sponsored the studies included, for providing data for this paper.

Drs. Rabinowitz and Davidson have served as consultants for Janssen. Dr Katz has served as a consultant for Johnson & Johnson. Dr. De Deyn has served as a consultant for Johnson & Johnson and has participated in speakers' or advisory boards for Bristol-Myers Squibb, Johnson & Johnson, and Eli Lilly. Dr. Brodaty has served as a consultant for, received grant/research support from, and participated in speakers' or advisory boards for Janssen. Dr. Greenspan is an employee of Janssen.

Corresponding author and reprints: Jonathan Rabinowitz, Ph.D., Bar Ilan University, Ramat Gan, Israel (e-mail: jrabin@netvision.net.il).