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May 11, 2005

Pharmacological Treatment of Neuropsychiatric Symptoms of Dementia—Reply

JAMA. 2005;293(18):2211-2212. doi:10.1001/jama.293.18.2212-b

In Reply: We agree with the points raised by Drs Steinberg and Lyketsos. Most of the drug trials for neuropsychiatric symptoms enrolled patients with very heterogeneous symptoms and measured outcomes with composite symptom scores, such as the Neuropsychiatric Inventory or the Behavioral Pathology in Alzheimer Disease rating scale (BEHAVE-AD). This design may result in dilution of therapeutic benefits for certain symptom clusters. However, there have not been trials designed to assess the efficacy of drugs for specific symptom clusters. In addition, subgroup analyses have not consistently supported the hypothesis that selected drug therapy for specific symptom clusters is effective. For example, in a post hoc analysis of a trial comparing haloperidol with trazodone, improvement from haloperidol measured by the Cohen-Mansfield Agitation Inventory was not related to the severity of psychotic symptoms, although improvement from trazodone was associated with baseline depressive symptoms.1 Prospective trials of drug therapy targeting specific symptom clusters or “syndromes” are needed.

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