December 11, 1997 in Nation/World

Medication Promises To Quiet Violent Episodes Of Alzheimer’s

Lauran Neergaard Associated Press
 

A schizophrenia medicine is showing promise in treating some heart-rending complications of Alzheimer’s disease: the aggression and delusions that can lead patients to attack loved ones and nursing home workers.

A study of 625 patients in 40 U.S. nursing homes and hospitals found that low doses of the drug risperidone helped calm about a third of patients with Alzheimer’s and similar dementia without the troubling side effects of standard treatment, scientists announced Wednesday.

Today, medication often is a last-ditch effort to deal with the problem, and it is prescribed only after the patient hits someone or becomes too fearful to leave bed or talk to others, said lead investigator Dr. Ira Katz of the University of Pennsylvania.

“With a safer agent, we can really begin more use of the medicine not just to keep the (nursing home) aide from being slugged, but to help the patient enjoy life more,” said Katz, who presented his findings at a psychiatry meeting in Hawaii.

Janssen Pharmaceutica, which already sells risperidone for schizophrenia, funded the study. It plans to seek Food and Drug Administration approval next month to market it to dementia patients too.

One-third of Alzheimer’s patients develop psychotic symptoms - aggression, delusions, hallucinations - in addition to the memory loss and confusion that characterize the incurable disease. Psychoses also are common in dementias caused by stroke. These behavioral problems are a leading reason dementia patients are put in nursing homes.

One study participant, 83-year-old stroke patient Jimmy Dunne, was so aggressive that his Queens, N.Y., nursing home complained almost daily to family members. Another drug merely sedated him, but risperidone restored a cheerful personality in his final months, said daughter Lorraine Fitzpatrick.

“He seemed happy. The nurses would play some songs and he would actually tap his feet,” she said. “I honestly felt that had he not been on it, he would have been just an angry, horrible person until the day he died.”

Risperidone’s effect was not huge: 36 percent of study patients who took 1 milligram a day had a 60 percent improvement in psychotic symptoms. But 22 percent of patients who took a dummy pill also improved that much.

These symptoms tend to wax and wane, explaining part of the high placebo effect, said Dr. Peter Whitehouse of the University Hospitals of Cleveland, who reviewed the study for Janssen. All study participants also received special psychological care that doctors already knew can help sufferers in nursing homes.

But Katz said risperidone’s advantage is that it helps a significant number of patients while causing none of the extreme sedation and rigid muscles - Parkinson’s disease-like symptoms - of standard treatments.

“This medicine is useful,” agreed Dr. Barry Reisberg, a well-known Alzheimer’s expert, saying the study provides long-needed information to doctors who now prescribe psychiatric drugs “haphazardly.”

He urged doctors to try psychological therapy before prescribing any drugs. Anti-psychotic drugs “have been misused and misapplied to Alzheimer’s patients (who) are very, very susceptible to certain kinds of side effects,” said the psychology professor who heads New York University’s Fisher Alzheimer’s Disease Program.

Katz said risperidone may be more effective on the most aggressive patients, people he eliminated from his research for fear they would attack study coordinators.

Whitehouse said the drug also may help patients remain at home. If patients are calm enough to enroll in such programs as day care that give relatives a rest, he said, “It’s less likely that patient would be admitted to a nursing home.”

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