International Psychogeriatrics

Review Article

Management of behavioral problems in Alzheimer's disease

Serge Gauthiera1 c1, Jeffrey Cummingsa2, Clive Ballarda3, Henry Brodatya4, George Grossberga5, Philippe Roberta6 and Constantine Lyketsosa7

a1 Alzheimer's Disease and Related Disorders Unit at the McGill Center for Studies in Aging, Douglas Mental Health University Institute, Montreal, Canada

a2 Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, California, U.S.A.

a3 Age Related Diseases, King's College London, London, U.K.

a4 Primary Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia

a5 Department of Neurology and Psychiatry, St Louis University School of Medicine, St Louis, Missouri, U.S.A.

a6 Centre Mémoire de Ressources et de Recherche (Memory Centre for Care and Research), CHU de Nice, Hôpital Pasteur, Nice, France

a7 Department of Psychiatry, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.


Alzheimer's disease (AD) is a complex progressive brain degenerative disorder that has effects on multiple cerebral systems. In addition to cognitive and functional decline, diverse behavioral changes manifest with increasing severity over time, presenting significant management challenges for caregivers and health care professionals. Almost all patients with AD are affected by neuropsychiatric symptoms at some point during their illness; in some cases, symptoms occur prior to diagnosis of the dementia syndrome. Further, behavioral factors have been identified, which may have their origins in particular neurobiological processes, and respond to particular management strategies. Improved clarification of causes, triggers, and presentation of neuropsychiatric symptoms will guide both research and clinical decision-making. Measurement of neuropsychiatric symptoms in AD is most commonly by means of the Neuropsychiatric Inventory; its utility and future development are discussed, as are the limitations and difficulties encountered when quantifying behavioral responses in clinical trials. Evidence from clinical trials of both non-pharmacological and pharmacological treatments, and from neurobiological studies, provides a range of management options that can be tailored to individual needs. We suggest that non-pharmacological interventions (including psychosocial/psychological counseling, interpersonal management and environmental management) should be attempted first, followed by the least harmful medication for the shortest time possible. Pharmacological treatment options, such as antipsychotics, antidepressants, anticonvulsants, cholinesterase inhibitors and memantine, need careful consideration of the benefits and limitations of each drug class.

(Received August 10 2009)

(Revised October 05 2009)

(Revised November 02 2009)

(Accepted November 06 2009)

(Online publication January 25 2010)