Interaction Between anti-Alzheimer’s Disease Drugs and Antipsychotic Agents in the Treatment of Behavioral and Psychological Symptoms: Extrapyramidal Side Effects

Alzheimer’s disease (AD) is the most common dementia type, accounting on its own for almost 70% of all dementia cases. Behavioral and psychological symptoms of dementia (BPSD) afflict most patients with dementia, especially those with Alzheimer’s disease (AD). Treatment options for BPSD include pharmacological and nonpharmacological approaches. However, behavioral symptoms are not always controllable with non-pharmacological intervention, and the psychotropic class of medication more frequently prescribed for behavioral symptoms are atypical antipsychotics. Antipsychotic drugs are often used for the treatment of BPSD. They are prescribed alone or in conjunction with anti-dementia. However, antipsychotic therapy is not free from several, and often serious, adverse events. For instance, it is well known that antipsychotic drugs commonly cause serious extrapyramidal side effects (EPS). It is imperative for clinicians to understand that 5-HT1A receptors or blockade of 5-HT2, 5-HT3 and 5-HT6 receptors can alleviate EPS induction by antipsychotics agent. It is therefore important to understand that appropriate drug choice and combination strategy are important in the treatment of BPSD. I point out that antipsychotic drugs can have extrapyramidal side effects, including parkinsonian symptoms, also when used in AD, and argument drug choice and combination strategies as cholinesterase inhibitors and antipsychotic drugs. Additionally, the advantages and limitation of antipsychotic drugs have been evaluated.