International Psychogeriatrics

Research Article

Escitalopram versus risperidone for the treatment of behavioral and psychotic symptoms associated with Alzheimer's disease: a randomized double-blind pilot study

Yoram Baraka1 c1, Igor Plopskia1, Shelly Tadgera1 and Diana Paleacua1

a1 Abarbanel Mental Health Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel


Background: Antipsychotics are frequently used to treat psychosis, aggression and agitation in patients with Alzheimer's disease (AD), but safety warnings abound. Escitalopram was investigated since citalopram has demonstrated some effectiveness in AD. We compared escitalopram and risperidone for psychotic symptoms and agitation associated with AD.

Methods: Inpatients with AD, who had been hospitalized because of behavioral symptoms, were recruited to a six-week randomized, double-blind, controlled trial. Participants (n = 40) were randomized to once daily risperidone 1 mg or escitalopram 10 mg.

Results: The NPI total score improved in both groups. Onset was earlier in the risperidone-treated group, but improvement did not significantly differ between groups by study end. Completion rates differed for escitalopram (75%) and risperidone (55%), mainly due to adverse events. There were no adverse events in the escitalopram group, while in the risperidone group two patients suffered severe extrapyramidal symptoms and four patients suffered acute physical illness necessitating transfer to general hospital.

Conclusion: Escitalopram and risperidone did not differ in efficacy in reducing psychotic symptoms and agitation in patients with AD. Completion rates were higher for escitalopram-treated patients. Replication in larger trials with ambulatory patients is needed.

(Received October 11 2010)

(Revised February 06 2011)

(Revised March 10 2011)

(Accepted March 14 2011)

(Online publication April 15 2011)


c1 Correspondence should be addressed to: Yoram Barak, MD, MHA, Director of Psychogeriatrics, Abarbanel MHC, 15 KKL Street, Bat-Yam, 59100, Israel. Phone and Fax: +972-3-5552738. Email: