A large, federally funded study testing three second-generation “atypical” antipsychotic drugs to treat behavioral Alzheimer symptoms found all three gave physicians an overall impression the drugs were helping about 30 percent of the time. However, their benefit did not differ significantly from a placebo (a look-alike “dummy treatment”), which seemed to help about 20 percent of the time.

All of the drugs were associated with one or more serious side effects, including muscle spasms, tremors and other involuntary movements, sedation and confusion. There were no significant differences in the average length of time participants were able to take any of the drugs before study physicians stopped them due to lack of benefit or side effects. Findings appear in the Oct. 12 New England Journal of Medicine.

“This large, well-designed trial supports an emerging clinical consensus that while antipsychotic drugs continue to have a place in treating behavioral Alzheimer symptoms under some circumstances, the decision to use them needs to be thoughtfully considered, closely monitored and carefully tailored to the situation,” says William H. Thies, Ph.D., Alzheimer’s Association vice president of medical and scientific relations.

“Combativeness, agitation, anxiety, excessive suspiciousness and other behavioral manifestations can be among the most troubling aspects of the disease for diagnosed individuals and family and professional caregivers,” Thies notes. “Although every effort should be made to find non-drug strategies to reduce these symptoms, sometimes medications may need to be considered when other approaches don’t help.”

The study enrolled 421 individuals, 57 percent needing a level of care equivalent to assisted living and 17 percent requiring the equivalent of nursing home care. After 12 weeks of treatment, physicians felt there was at least a modest overall improvement in 32 percent of those taking olanzapine (Zyprexa), 26 percent taking quetiapine (Seroquel), 29 percent taking risperidone (Risperdal) and 21 percent taking the placebo.

Common side effects included parkinsonism and involuntary movement (12 percent in the olanzapine and risperidone groups, 2 percent in the quetiapine group, and 1 percent in the placebo group); sedation (15 to 24 percent in the three treatment groups, 5 percent in the placebo group); and confusion (18 percent in the olanzapine group, 11 percent in the risperidone group and 5 percent in the placebo group). Participants tended to gain weight with olanzapine and risperidone and to lose weight on the placebo.

Few studies have directly compared the effectiveness of different atypical antipsychotic drugs as treatments for behavioral Alzheimer symptoms. This study was funded by the National Institute of Mental Health (NIMH), one of the U.S. National Institutes of Health.

For more information:

• For a detailed discussion of behavioral and psychiatric Alzheimer symptoms and non-drug and drug treatment approaches, please see .