| Atypical antipsychotic shows promise in controlling behavior in patients with early Alzheimer's disease Quetiapine, an atypical antipsychotic agent, shows promise for controlling psychotic symptoms found among patients in the early stages of Alzheimer's disease, according to an article in the April-June issue of the journal Alzheimer Disease and Associated Disorders. "Quetiapine should be considered the first line of treatment for psychosis in Alzheimer's patients because of its lack of serious side effects," said Douglas Scharre, M.D., lead author. Scharre added that although no antipsychotic medication is currently approved in the U.S. to treat Alzheimer's-related psychosis, physicians can prescribe it for that use. An estimated 4 million people in the United States have the disease. Scharre and coauthor Shu-Ing Chang prescribed quetiapine (Seroquel) to patients with mild to moderate Alzheimer's disease. Their study is the first to look at the effects of an atypical antipsychotic agent on cognitive function in patients with the disease. The researchers recruited 10 outpatients with a diagnosis of probable Alzheimer's disease and with symptoms of psychotic or aggressive behaviors sufficiently severe to justify drug treatment on a regular basis. Quetiapine was the only antipsychotic medication prescribed during the 12-week study. The researchers evaluated subjects at baseline and at 6 and 12 weeks. They measured behavioral symptoms using the Neuropsychiatric Inventory and evaluated cognitive abilities using the Alzheimer's Disease Assessment Scale-cognitive subscale. Patients had a physical examination at each visit. Subjects were monitored weekly via telephone. The subjects began by taking 25 mg of quetiapine each night at bedtime. Dosages were increased by 25 mg weekly if symptoms of aggression and psychosis were still evident. The average dose of quetiapine at the end of the study was 50 mg twice daily. Dosing ranged from 50 mg to 150 mg daily per patient. "Schizophrenics don't show much of a response until the dose is 150 mg or higher, and may require up to 600 to 800 mg of quetiapine to ease psychotic symptoms," Scharre said. At the end of the current study, quetiapine at the 50 to 150 mg level did not significantly worsen cognitive function in the Alzheimer's subjects. In fact, the average cognitive subscale scores improved slightly after 6 weeks. "The decrease in aggression and psychotic behavior at this point may also have contributed to the improvement in cognitive scores," Scharre said. However, cognitive scores at 12 weeks decreased slightly from baseline. Scharre believes this is more likely to represent natural disease progression rather than drug use. The average Alzheimer's patient in the early to middle stages of the disease will usually show a decrease in cognition of 5 to 11 points annually on the cognitive subscale scale, a loss of about 1 to 3 points every three months. The cognition of the subjects in the current study decreased an average of 2.4 points during the 12-week study. Scharre noted that drug use did not appear to increase the rate of cognitive loss, emphasizing that "A physician hopes to help patients retain as much cognitive function as possible, in a disease where cognitive decline is the norm." Other side effects included occasional drowsiness (4 of 10 patients). In addition, 4 of the 10 patients gained an average of four pounds while taking the drug, which might be beneficial in a population that has weight loss as a common problem. "While many of the currently available
medications work well in controlling psychosis, they can cause confusion
or Parkinson's disease-like symptoms, such as increased stiffness
and tremor," said Scharre. He suggested that the absence of
dizziness and feelings of stiffness of imbalance indicates that
quetiapine use in this largely elderly, somewhat frail population
may not be associated with an increased risk of injury in falls. |