Study results released today on the effectiveness of antipsychotics to treat symptoms of Alzheimer’s disease underscore that AD is not just a neurological disorder of memory impairment but has complex neuropsychiatric symptoms, said Christopher C. Colenda, MD, MPH, president of the American Association for Geriatric Psychiatry. Results of the trial, known as the Clinical Antipsychotic Trial of Intervention Effectiveness study for Alzheimer’s disease (CATIE-AD), sponsored by the National Institutes of Health’s National Institute of Mental Health (NIMH), were published in the October 12, 2006, issue of the New England Journal of Medicine.

According to NIMH, “commonly prescribed antipsychotic medications used to treat Alzheimer’s patients with delusions, aggression, hallucinations, and other similar symptoms can benefit some patients, but they appear to be no more effective than a placebo when adverse side effects are considered.” See NIMH press release: www.nimh.nih.gov/press/catie_ad.cfm.
For NIMH Questions and Answers on the CATIE-AD trial:
www.nimh.nih.gov/healthinformation/catie_alzheimers_qa.cfm

“Neuropsychiatric symptoms are part of the disease course for Alzheimer’s disease (AD) patients. These symptoms increase the risk of institutionalization and, unfortunately, do not disappear when a patient is institutionalized,” said Colenda. “Documenting efficacious and effective treatments is a critical area of research, and the importance of this study is that it mirrored real-world clinical practice.”

“We need a fresh approach to figuring out how to manage these patients. This includes not only developing effective treatments for the underlying pathology of Alzheimer’s, but also, renewing efforts to study psychosocial and behavioral interventions, and alternative pharmacotherapeutic approaches to these symptoms. It is important to understand that many of these symptoms are transitory, and clinicians need a different mindset on how best to approach these difficult situations,” said Colenda. “Importantly, because patients with AD can have major psychiatric problems, Alzheimer’s should be part of the NIMH’s portfolio of research.”

The AAGP applauds the NIMH for funding the CATIE-AD study, and examining “real-world practices,” including the reduction of symptoms as well as medication switches, over a long time period. “Short-term studies, those designed to establish efficacy, miss the broader issues of effectiveness.” The CATIE-AD study also focused on tolerability and adverse events, drawing needed attention to the critical importance of careful monitoring and individualization of care.

Colenda cautioned regulatory agencies to not over respond to the findings of the CATIE-AD by preventing physicians from exercising clinical judgment as to whether or not to prescribe antipsychotics. Colenda added: “We need more translational research that is focused on clinical and evidence-based protocols designed to help physicians know when and how to start, continue, and discontinue psychotropic medications.”

The American Association for Geriatric Psychiatry (www.AAGPonline.org) is a national association representing and serving its members and the field of geriatric psychiatry. AAGP’s mission is to enhance the knowledge base and standard of practice in geriatric psychiatry through education and research and to advocate for meeting the mental health needs of older Americans.

CONTACT:
Kate McDuffie
kmcduffie@aagponline.org
301-654-7850, x 113