Psychotropic drugs for the behavioural and psychological symptoms of dementia: no free ride

Nearly 70% of long-term care residents in Canada have dementia, and, at some point, most experience associated behavioural and psychological symptoms, which include disordered perception, thought content, mood or behaviour. Behavioural and psychological symptoms of dementia are among the most challenging and stressful aspects of caring for people with dementia.2 Despite only modest evidence of benefit, antipsychotics are commonly prescribed to older adults with dementia, including nearly 40% of the Canadian population living in long-term care who had at least 1 claim for an antipsychotic in 2014. Since the early 2000s, concerns have emerged about the safety of these agents, such as an increased risk of death and cerebrovascular events among adults with dementia. This evidence prompted warnings from regulatory agencies and widespread efforts for more judicious prescribing of antipsychotics to older adults with dementia. Trazodone has been increasingly used as an alternative option for the management of behavioural and psychological symptoms of dementia, despite inconclusive evidence about its benefit.