The likelihood of behavioural and psychological symptoms of dementia (BPSD) increases in the later stages of dementia. Antipsychotics (mainly prescribed off label) may be suitable for people with Alzheimer’s who are at risk of harming themselves or others, or who are experiencing agitation, hallucinations or delusions that are causing severe distress.^4,8

However, there is an increased risk of cerebrovascular adverse events and greater mortality if using antipsychotics to treat BPSD. Antipsychotics can worsen the motor features if given to people with dementia with Lewy bodies or Parkinson's dementia.^8,34

Haloperidol is indicated for persistent aggression and psychotic symptoms in moderate to severe Alzheimer's dementia and vascular dementia (when non-pharmacological treatments are ineffective and there is a risk of harm to the patient or others). Risperidone is similarly indicated in Alzheimer’s for short-term treatment up to 6 weeks.³⁵

For mild to moderate depression and/or anxiety in mild to moderate Alzheimer’s, psychological treatments are preferred. Antidepressants should be avoided unless indicated for a pre-existing severe mental health problem.⁸

Dementia symptoms can be influenced by other conditions, so it is important these are diagnosed and managed appropriately. This can include stroke, hypertension, high cholesterol levels, other cardiovascular conditions, diabetes, kidney disease, and depression.⁴