Article

Risperidone in the Treatment of Psychosis of Alzheimer Disease: Results From a Prospective Clinical Trial

Department of Psychiatry and Behavioral Sciences, VA Medical Center, Medical University of South Carolina, Charleston, 29406, USA.
American Journal of Geriatric Psychiatry (Impact Factor: 3.52). 04/2006; 14(3):280-91. DOI: 10.1097/01.JGP.0000194643.63245.8c
Source: PubMed

ABSTRACT The objective of this study was to evaluate efficacy and safety of low-dose risperidone for treating psychosis of Alzheimer disease (AD).
The authors conducted a randomized, eight-week, double-blind, placebo-controlled, multicenter trial involving nursing home residents diagnosed with AD and psychosis. Four hundred seventy-three patients were randomly assigned to placebo (N = 238) or 1.0 to 1.5 mg risperidone per day (N = 235). Coprimary efficacy end points were: changes in scores on the Behavioral pathology in Alzheimer's Disease (BEHAVE-AD) Psychosis subscale and Clinical Global Impression of Change (CGI-C). Protocol-specified subgroup analyses were performed by demographics and dementia severity.
Efficacy analysis included 416 patients. Both groups improved significantly on the BEHAVE-AD Psychosis subscale and CGI-C with no significant difference between groups. In the subgroups analyses, a statistically significant treatment by Mini-Mental Status Examination (MMSE) interaction on the CGI-C (F([2,381]) = 3.90, p = 0.021) was observed with patients with more severe dementia (MMSE <10) showing significant differences at end point favoring risperidone treatment (chi(2) ([1]) = 5.11, p = 0.024). Mean risperidone dose was 1.03 +/- 0.24 mg per day. All-cause discontinuation rates were 25% for both risperidone and placebo. Treatment-emergent adverse events occurred in 74% risperidone versus 64% placebo patients, with somnolence occurring significantly more frequently with risperidone (16.2% versus 4.6%). Nine (3.8%) risperidone- and six (2.5%) placebo patients died during or within 30 days after treatment.
This trial did not confirm earlier findings in this population.

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    • "The median trial duration was 56 days (range = 1–90 days). A variety of outcome measures were reported in studies including composite measures of NPS (Barnes et al., 1982; Cantillon et al., 1996; Tariot et al., 1998; 2001; 2005; 2006; De Deyn et al., 1999; 2004; Katz et al., 1999; Street et al., 2000; Porsteinsson et al., 2001; Fontaine et al., 2003; Peskind et al., 2005; Gehrman et al., 2009; Sommer et al., 2009; Wang et al., 2009), agitation (Gaber et al., 2001; Ballard et al., 2005; Verhey et al., 2006; Holmes et al., 2007; Zhong et al., 2007; Rappaport et al., 2009,), aggression (Kyomen et al., 1999; Brodaty et al., 2003; Hall et al., 2005; Huertas et al., 2007), or psychosis (Mintzer et al., 2006; 2007; Streim et al., 2008). "
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