Question

A 77-year-old man with moderate-to-severe Alzheimer-type dementia (AD) is brought in for evaluation by his daughter who acts as his healthcare proxy. She explains that he has begun angry outbursts triggered by minor issues. The patient and family are quite bothered by these events. She asks about the use of medication to help minimize these outbursts. In considering the use of a second-generation antipsychotic in the older adult, the NP explains the use of this drug class:

a) Can slow progression of AD.
b) Can increase the risk of stroke and cardiovascular events.
c) Is contraindicated in patients with AD.
d) Is best to start at a higher dose until therapeutic effect is seen and then titrate to a lower dose.

Answer 1

Second-generation antipsychotics can be used to manage behavioral symptoms in patients with Alzheimer's disease, but their use should be carefully evaluated due to potential risks. They do not slow the progression of the disease and may increase the risk of stroke and cardiovascular events. Starting at a lower dose and titrating up is recommended.

Step-by-step explanation:

Second-generation antipsychotics, also known as neuroleptic drugs, are sometimes used to manage behavioral symptoms in patients with Alzheimer's disease (AD). These drugs can help reduce angry outbursts triggered by minor issues in patients with moderate-to-severe AD. However, it is important to consider the potential risks and benefits of using these medications.

1. Can slow progression of AD: Second-generation antipsychotics do not slow the progression of AD. They primarily work to manage the behavioral symptoms and improve quality of life for patients.
2. Can increase the risk of stroke and cardiovascular events: The use of second-generation antipsychotics in older adults, including those with AD, has been associated with an increased risk of stroke and cardiovascular events. Therefore, careful consideration of the risks and benefits is essential.
3. Is not contraindicated in patients with AD: Second-generation antipsychotics are not contraindicated in patients with AD. However, their use should be carefully evaluated and monitored by healthcare professionals.
4. Is best to start at a lower dose and titrate up: It is generally recommended to start with a low dose of second-generation antipsychotics in older adults and titrate up based on individual response and tolerability.