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Allow us to set the stage. You have a serious but common problem that has major emotional and financial implications for patients, caregivers, and society. There are a variety of therapeutic approaches, none of which has been extensively researched or studied “head-to-head.” You assemble a formidable team of experienced investigators and design a model study to compare three of the most highly recommended approaches against placebo. These investigators recruit a sufficient number of subjects and analyze the data appropriately. Finally, the results provide clinicians with firm, evidence-based recommendations for treatment. Sound too good to be true? Unfortunately, it is. The Alzheimer’s Disease Cooperative Study (ADCS) of the treatment of agitation in AD1 followed the plot exactly, right up to but not including the punch line.
Behavioral and psychological symptoms in dementia (BPSD) are common, serious problems that affect the quality of life of both patient and caregiver, and frequently result in premature institutionalization. BPSD include agitation, aggression, delusions, hallucinations, depression, apathy, sleep disturbance, and sexually inappropriate behaviors. These difficulties occur in up to 90% of patients at some point in …
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