Treatment of the elderly suffering from psychosis and dementia.

Studies with elderly demented subjects have suggested that overt hostility, agitation, hallucinosis, and hyperactivity are the most likely symptom profiles to respond to neuroleptics, but the available research data do not point to any one clear choice of medications. Meanwhile, recent government regulations require specific diagnosis-related indications for the use of neuroleptics. Unfortunately, there is still a general shortage of double-blind, placebo-controlled studies with either typical or atypical neuroleptics. Clinical treatment with neuroleptics requires careful evaluation of all extrapyramidal and possible cognitive side effects, especially with drugs having high anticholinergic potency. The long-term risk-benefit ratio for the use of typical or atypical neuroleptics in elderly demented patients is also uncertain, so adequate consideration should be given to non-neuroleptic medications before initiating a long-term trial of neuroleptics.