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A common misconception is that Alzheimer’s patients are placed in a nursing home because their memory has failed. Actually, what is more disturbing and precedes placement in a nursing home are the periods of agitation and psychotic symptoms (hallucinations, delusions, suspicious thoughts) often experienced in the later stages of Alzheimer’s disease.

Traditional thinking is that psychotic episodes of Alzheimer’s patients should be given the same medication as young people with schizophrenia, who also suffer psychotic episodes. Commonly, the anti-psychotic drug given is risperidone. At issue are the negative side-effects of the drug in the elderly, which is an increased risk of heart failure resulting in sudden death.

In a 12-week clinical trial approximately 100 Alzheimer’s patients were randomly selected to 1 of 2 groups. One group was given risperidone and the other group was given citalopram. Citalopram is an antidepressant that poses a far less risk of side-effects than that of risperidone.

Researchers were surprised to find that citalopram and risperidone had similar efficacy in reducing psychosis and agitation. Citalopram reduced psychotic symptoms by 32% and risperidone reduced symptoms by 35%. As expected, citalopram demonstrated fewer adverse effects, such as sedation, tension, and apathy. Total side effect burden scores increased 19% for risperidone and decreased by 4% with citalopram.

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