For many years typical antipsychotic drugs were the most common treatment in management of the behavioural symptoms of dementia, in psychosis and mania in older people. Although there has been extensive experience with their use, this drugs are only modestly effective and have potentially serious adverse effects that, limit their usefulness in older adults. Atypical antipsychotics and mood stabilizers are efficacious treatment in mania and are increasingly used also to treat aggressiveness and agitation in older patients without psychosis.
Although some placebo-controlled trials and meta-analysis of antipsychotic drugs, mood stabilizers and cholinesterase inhibitors have show statistically signifi cant differences favoring their use, the magnitude of effect is small.
If pharmacotherapy is considered necessary, it should be tailored to the individual and balanced against the serious potential risk associated with therapy, including cerebrovascular adverse events, increased mortality and trombocythopenia, and drug interactions.