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The Relationship Between Antipsychotic Treatment and Quality of Life for Patients With Dementia Living in Residential and Nursing Home Care Facilities

Clive G. Ballard, MRCPsych, MD, and Marisa L. Margallo-Lana, MRCPsych

Published: July 1, 2004

Article Abstract

For any treatment, the impact on quality of life (QoL) is a key consideration. These issues are particularlyimportant in the pharmacologic management of behavioral and psychological symptoms inpatients with dementia (BPSD). Although these symptoms can be very distressing for some patients,the overall relationship of the symptoms with QoL is far less clear. In addition, although antipsychoticagents have moderate efficacy in the short- to medium-term management of these symptoms, it cannotbe assumed that symptom resolution automatically equates with improved QoL. This is of particularconcern in light of the adverse side effect profiles of many of these agents. Indeed, the only empiricalstudy in this area conducted to date indicated that antipsychotics are associated with a worse QoL fornursing home patients. Unfortunately, none of the placebo-controlled trials of antipsychotics for thetreatment of BPSD have included formal QoL measures, although preliminary evidence indicates thatatypical antipsychotics such as quetiapine may result in QoL improvements. The inclusion of systematicQoL measures in future clinical trials is imperative in order to provide evidence to enable theclinician to make informed judgments regarding the potential benefits or risks of pharmacologic treatmentfor individual patients. In addition, such information will facilitate a better understanding of thelikely factors that may contribute to the impact of treatment on QoL (e.g., side effects) and henceenable physicians to make rational treatment choices between different pharmacologic agents.

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