Antipsychotics for elderly people with dementia: Which are best? 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However, these drugs can cause severe side effects, so doctors typically prescribe them only if alternative treatments are ineffective. This article explains what antipsychotic drugs are and which can help treat dementia. It also looks at their benefits, limits, and side effects. Finally, it discusses alternative treatments and when to seek medical advice. What is dementia Share on PinterestDesign by MNT; Photography by Westend61/Getty Images & Douglas Sacha/Getty ImagesDementia is a broad term that refers to a condition that can cause cognitive problems, which are difficulties a person may have when thinking, remembering, or completing tasks. Alzheimer’s disease is the most common form of dementia, affecting 60–80% of people with the condition. However, up to 90% of those with any form of dementia will develop NPSs such as:psychotic symptoms, including confused thinking or hallucinationsagitationexcessive talking or physical activitymood changessleep disorders The symptoms of dementia range from mild to completely debilitating and can worsen with time. The condition is more common in older people, but it is not an inevitable part of aging. What are antipsychotic drugs Antipsychotic medications can help manage symptoms of severe mental illness and prevent repeat episodes. These medications aim to treat symptoms of psychosis, a form of mental illness where people can experience a loss of contact with reality. Antipsychotics can help treat the following conditions:schizophreniadementiadeliriumdelusional disorderssevere agitationmajor depressive disorderborderline personality disordersubstance-induced psychotic disorder There are two main types of antipsychotic medications. The first generation, or typical antipsychotics, are dopamine receptor blockers that work by blocking dopamine receptors in the brain. Dopamine is a hormone that affects movement and feelings of reward and pleasure. The second generation, or atypical antipsychotics, are dopamine antagonists that block serotonin receptors and affect serotonin levels. Serotonin is a hormone that contributes to well-being and happiness. Learn more about second-generation antipsychotics. In 2005, the Food and Drug Administration (FDA) issued a black box warning regarding the use of antipsychotic medications to treat older adults with dementia. The FDA uses these warnings to make doctors and pharmacists aware of the medication’s potentially severe side effects. Antipsychotic medication for people with dementia If people with dementia behave aggressively or show symptoms of psychosis, doctors can first try behavioral interventions and medications such as antidepressants, antiepileptics, and anti-dementia drugs. If these medications and behavioral interventions are ineffective, providers may try antipsychotic medications, which may reduce the frequency and intensity of symptoms. However, typical antipsychotics may not be the best antipsychotics for older adults with dementia because of the risk of side effects. Typical antipsychotics include:Haloperidol (Haldol): The most common prescription typical antipsychotic for dementia. This medication is available by injection or orally. However, Haldol can cause serious side effects, so people should exercise caution when using then, even when the benefits outweigh the risks.Thiothixene (Navane): Doctors generally prescribe these for schizophrenia, but they have links to many potential side effects.Perphenazine (Trilafon): Doctors prescribe this to treat schizophrenia and nausea. People generally take this medication two to four times daily. Atypical antipsychotics for treating dementia include:Aripiprazole (Abilify): Some evidence suggests it can help reduce auditory hallucinations without increasing cardiac irregularity.Risperidone (Risperdal): This has approval for short-term use in the United Kingdom to treat aggression in people with Alzheimer’s disease, but it does not have approval in the United States. Doctors prescribe atypical antipsychotics more often than typical antipsychotic agents due to their reduced risk of side effects. However, the former can still cause side effects, so people should speak with a doctor to discuss the benefits and risks. Off-label antipsychotics When the FDA approves drugs, they approve them for a specific purpose, such as treating schizophrenia. However, once the drug is in use, healthcare professionals might find that it is also effective for other conditions, such as dementia. Doctors may then prescribe it for other conditions because of this effect. This practice is called off-label use. Doctors can legally prescribe antipsychotics off-label to treat serious dementia symptoms, such as hallucinations and agitation. Some types of off-label antipsychotic medication for dementia include:Olanzapine (Zyprexa): Doctors typically prescribe this for schizophrenia or bipolar disorder. However, it does not have current approval for treating dementia and may increase the risk of a mini-stroke, stroke, or death.Quetiapine (Seroquel): Doctors usually prescribe this to treat depression or mania. While it does not have approval for use in people with dementia, a person taking this medication will often start with a small dose, which a doctor gradually increases.Ziprasidone (Geodon): This medication for treating schizophrenia and bipolar disorder may increase blood sugar levels. Benefits Using antipsychotic medications can provide small but noticeable benefits to people with Alzheimer’s disease, vascular dementia, or mixed dementia. Antipsychotics can help reduce the following symptoms in people with dementia:agitationaggressive behaviorsymptoms of psychosis Learn more about the stages of dementia. Limits Even the most effective antipsychotics for older adults with dementia will not be able to address:wanderingrepetitive speakinga lack of inhibitions in certain settingssocial isolation Learn more about the symptoms of dementia in older adults. Side effects Antipsychotic medications come with serious health risks. The risks are so high and severe that the FDA issued a black box warning about using antipsychotic medications to treat dementia. These side effects include:a greater risk of strokean increased risk of mortalitystiffnessdifficulty movingmore frequent fallssedationcognitive decline Additionally, people with Lewy body dementia or dementia due to Parkinson’s disease can have severe adverse reactions to antipsychotic medications. Caregivers should monitor them closely if a doctor prescribes these treatments. Learn more about the side effects of antipsychotics. Other treatment options Antipsychotic medications are not the only way to treat NPSs in people with dementia. Doctors usually only recommend them if nonpharmacological options and other medications have not worked. Nonpharmacological options include:psychotherapymusic therapyexercisepromoting social engagement with stimulating activities Learn more about the best activities for people with dementia. Other medications for treating dementia include:antidepressantsanti-dementia drugsantiepileptic drugs Behavioral problems and cognitive challenges in people with dementia may also be due to other health issues. Older adults with dementia tend to have many other health conditions. Individuals may take medications for different conditions, which increases their risk for adverse reactions and drug interactions. Drug interactions can affect a person’s ability to think clearly. Symptoms of urinary tract infections (UTI), which are common among older adults, are similar to NPSs. They include:hallucinationsaggressionconfusionanxiety Treating a UTI, if present, could provide relief from what appears to be NPSs due to dementia. When to speak with a doctor Dementia is a serious and generally progressive condition that greatly interferes with a person’s daily life. It can also be very difficult for care providers, friends, and family of someone with dementia. If a person notices behavioral problems and cognitive challenges that could be dementia-related NPSs, it is best to speak with a doctor as soon as possible. Additionally, individuals can consider discussing using antipsychotic medication to manage dementia if:people have concerns that the person could hurt themselves or othersthe individual with dementia is extremely agitatedother treatments do not work When looking for the best antipsychotic for older adults with dementia, people should ask doctors about the potential side effects of these medications and how to monitor them. Summary Dementia is a serious and generally progressive condition that greatly interferes with a person’s daily life. It can cause behavioral and cognitive problems. These symptoms can be quite serious and include aggression and psychosis symptoms, such as hallucinations. Antipsychotic medications can help provide some relief from these symptoms, but they come with the risk of severe side effects. Last medically reviewed on August 29, 2022Alzheimer's / DementiaCaregivers / HomecareSeniors / AgingDrugs 21 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Antipsychotics and other drug approaches in dementia care. (2021). https://www.alzheimers.org.uk/about-dementia/treatments/drugs/antipsychotic-drugsCalsolaro, V., et al. (2019). The use of antipsychotic drugs for treating behavioral symptoms in Alzheimer's disease. https://www.frontiersin.org/articles/10.3389/fphar.2019.01465/fullChokhawala, K., et al. (2021). Antipsychotic medications. https://www.ncbi.nlm.nih.gov/books/NBK519503/Delong, C., et al. (2022). Black box warning. https://www.ncbi.nlm.nih.gov/books/NBK538521/Haloperidol injection. (2017). https://medlineplus.gov/druginfo/meds/a615023.htmlHuang, Y.-T., et al. (2020). Pharmacological treatment of neuropsychiatric symptoms of dementia: A network meta-analysis protocol. https://atm.amegroups.com/article/view/45797/htmlJoshi, P., et al. (2020). Management of neuropsychiatric symptoms of dementia: Spotlight on QTc prolongation.https://psychiatryonline.org/doi/10.1176/appi.ajp-rj.2020.150304Kirkham, J., et al. (2017). Antipsychotic use in dementia: Is there a problem and are there solutions?https://journals.sagepub.com/doi/full/10.1177/0706743716673321Off-label drugs: What you need to know. (n.d.). https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.htmlOlanzapine. (2022). https://medlineplus.gov/druginfo/meds/a601213.htmlMueller, C., et al. (2021). Antipsychotic use in dementia: The relationship between neuropsychiatric symptom profiles and adverse outcomes. https://link.springer.com/article/10.1007/s10654-020-00643-2Perphenazine. (2018). https://medlineplus.gov/druginfo/meds/a682165.htmlQuetiapine. (2020). https://medlineplus.gov/druginfo/meds/a698019.htmlRubino, A., et al. (2020). Association of the US Food and Drug Administration antipsychotic drug boxed warning with medication use and health outcomes in elderly patients with dementia.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765053Suchonwanit, P., et al. (2019). Minoxidil and its use in hair disorders: A review.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/Sudden changes in behavior? Urinary tract infection could be the cause. (2020).https://www.alz.org/blog/alz/october_2011/sudden_change_in_behavior_urinary_tract_infectionThe dangers of polypharmacy and the case for deprescribing in older adults. (2021).https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adultsThiothixine. (2017). https://medlineplus.gov/druginfo/meds/a682867.htmlWhat is dementia Symptoms, type, and diagnosis. (2021). https://www.nia.nih.gov/health/what-is-dementiaWhat is psychosis? (n.d.). https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosisZiprasidone. 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