Risperidone in the management of psychiatric and neurodegenerative disease in the elderly: an update.

Neuropsychiatric disorders are common among elderly patients in long-term care facilities. Although dementia is most common, schizophrenia and schizoaffective disorder, delusional disorder, bipolar disorder, and Parkinson's disease, as well as other psychiatric and neurodegenerative disorders, can also occur in this population. Our objective was to review the literature pertaining to the safety and efficacy of risperidone in elderly patients, the atypical antipsychotic with the longest history of use in this population. We identified original studies of risperidone in elderly patients through MEDLINE and CURRENT CONTENTS database searches. Additional material was identified via abstracts presented at national and international conferences. Published data from controlled and uncontrolled trials in elderly patients support the efficacy of risperidone in controlling behavioral and psychological symptoms of dementia, as well as treating psychotic symptoms associated with schizophrenia and other disorders with psychotic features. Limited data suggest that risperidone might also be useful for management of patients with delirium and Huntington's disease. Risperidone was well tolerated in the elderly and associated with a low risk of movement disorders and anticholinergic effects. A recent change in the product information described an increased incidence of cerebrovascular events in some elderly and suggests the need for further investigations in this population. There is a substantial published database supporting safe and effective use of risperidone for treatment of psychosis, agitation, and aggression in elderly patients.