Olanzapine Treatment of Psychotic and Behavioral Symptoms in Patients With Alzheimer Disease in Nursing Care Facilities

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Abstract
PATIENTS WITH Alzheimer disease (AD) manifest not only progressive memory impairment, cognitive deficits, and functional alterations but also a variety of neuropsychiatric disturbances (agitation, aggression, hallucinations, delusions). These symptoms ultimately affect up to 75% of individuals with dementia1-6 and, once present, tend to be sustained or recurrent. A longitudinal assessment of 181 outpatients with AD and aggression or psychosis showed they were likely to exhibit recurrence of those symptoms during the following year (93% and 95%, respectively).7 Jeste and Finkel8 suggest the presumed disappearance of psychotic symptoms in patients with advanced stages of dementia could reflect an apparent, rather than real, remission because of patients' inability to articulate their delusions and hallucinations. Neuropsychiatric disturbances can affect caregivers and the overall management of the patient, including institutionalization and treatment choices. Despite the prevalence and impact of these disturbances, few studies have investigated the effect of patients' behaviors on staff at nursing care facilities. Neuropsychiatric symptoms may affect quality of patient care, increase staff supervision, and produce staff distress.9,10