Managing the burden of dementia-related delusions and hallucinations

Abstract

Neuropsychiatric symptoms such as delusions and hallucinations are commonly experienced by the estimated 8 million persons with dementia in the United States. Dementia-related delusions and hallucinations result in a wide variety of behavioral and psychological symptoms that contribute to substantial patient and caregiver burden and portend a more severe disease course of dementia. The diagnosis of dementia-related psychosis is based on clinical findings, with a key objective to rule out medical and other causes of the psychosis. Nonpharmacological approaches are generally first-line treatment, except when urgent symptom control is needed. None of the antipsychotics currently available are approved for dementia-related psychosis; in fact, antipsychotics are associated with increased mortality in older adults with dementia. Pimavanserin is an atypical antipsychotic with a unique mechanism of action that is approved for the treatment of hallucinations and delusions associated with PD psychosis; some evidence indicates the safety and effectiveness of pimavanserin for patients with dementia-related psychosis.