***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This r and omized , double-blind , placebo-controlled trial examined the efficacy and safety of risperidone in the treatment of aggression , agitation , and psychosis in elderly nursing-home patients with dementia . METHOD Elderly patients with a DSM-IV diagnosis of dementia of the Alzheimer 's type , vascular dementia , or a combination of the 2 ( i.e. , mixed dementia ) and significant aggressive behaviors were r and omized to receive , for a period of 12 weeks , a flexible dose of either placebo or risperidone solution up to a maximum of 2 mg/day . Outcome measures were the Cohen-Mansfield Agitation Inventory ( CMAI ) , the Behavioral Pathology in Alzheimer 's Disease ( BEHAVE-AD ) rating scale , and the Clinical Global Impression of Severity ( CGI-S ) and of Change ( CGI-C ) scales . RESULTS A total of 345 patients were r and omized to treatment with risperidone or placebo , and 337 patients received at least one dose of study drug . The trial was completed by 67 % of patients in the placebo group and 73 % of patients in the risperidone group . The mean + /- SE dose of risperidone was 0.95 + /- 0.03 mg/day . The primary endpoint of the study , the difference from baseline to endpoint in CMAI total aggression score , showed a significant reduction in aggressive behavior for risperidone versus placebo ( p < .001 ) . A similar improvement was also seen for the CMAI total non-aggression subscale ( p < .002 ) and for the BEHAVE-AD total ( p < .001 ) and psychotic symptoms subscale ( p = .004 ) . At endpoint , the CGI-S and the CGI-C scores indicated a significantly greater improvement with risperidone compared with placebo ( p < .001 ) . Overall , 94 % and 92 % of the risperidone and placebo groups , respectively , reported at least 1 adverse event . Somnolence and urinary tract infection were more common with risperidone treatment , whereas agitation was more common with placebo . There was no significant difference in the number of patients who reported extrapyramidal symptoms between the risperidone ( 23 % ) and placebo ( 16 % ) groups . CONCLUSION Treatment with low-dose ( mean = 0.95 mg/day ) risperidone result ed in significant improvement in aggression , agitation , and psychosis associated with dementia BACKGROUND Psychotic symptoms and behavioral disturbances are a leading cause of institutionalization in elderly patients with Alzheimer 's disease ( AD ) . OBJECTIVES Elderly nursing home patients ( n=105 ) with possible or probable AD were entered into a multicenter study to determine the long-term efficacy and safety of olanzapine in treatment of psychotic symptoms and behavioral disturbances due to AD . METHODS Following a double-blind , 6-week exposure to fixed-dose olanzapine ( 5 , 10 , or 15 mg/d ) , patients entered an additional 18-week , open-label , flexible-dose treatment . Baseline was defined from the start of the extension phase . RESULTS Patients improved significantly on the primary efficacy measure , defined a priori , which consisted of the sum of the Agitation/Aggression , Delusions , and Hallucinations items ( ' Core ' : ) of the NPI/NH . Olanzapine also significantly improved scores for the NPI/NH total and the Core item-associated Occupational Disruptiveness of the NPI/NH , as well as the BPRS total and CGI Severity-of-Alzheimer 's scores . Barnes Akathasia scores improved significantly from baseline , while Simpson-Angus and AIMS scores were not significantly changed . Treatment-emergent symptoms included somnolence , accidental injury , and rash . No significant changes were seen in ECGs , including QT(c ) interval , nor in weight or vital signs , including orthostasis . CONCLUSIONS Low-dose olanzapine appears to be effective and well tolerated for treatment of behavioral disturbances and psychotic symptoms due to AD in elderly patients BACKGROUND Although psychoactive medications have substantial side effects in the elderly , these drugs are used frequently in nursing homes . Few interventions have succeeded in changing this situation , and little is known about the clinical effects of such interventions . METHODS We studied six matched pairs of nursing homes ; at one r and omly selected nursing home in each pair , physicians , nurses , and aides participated in an educational program in geriatric psychopharmacology .  At base line we determined the type and quantity of drugs received by all residents ( n = 823 ) , and a blinded observer performed st and ardized clinical assessment s of the residents who were taking psychoactive medications .  After the five-month program , drug use and patient status were reassessed . RESULTS Scores on an index of psychoactive-drug use , measuring both the magnitude and the probable inappropriateness of medication use , declined significantly more in the nursing homes in which the program was carried out ( experimental nursing homes ) than in the control nursing homes ( decrease , 27 percent vs. 8 percent ; P = 0.02 ) . The use of  antipsychotic drugs  was discontinued in more residents in the experimental nursing homes than in the control nursing homes ( 32 percent vs. 14 percent ) ; the comparable figures for the discontinuation of long-acting benzodiazepines were 20 percent vs. 9 percent , and for antihistamine hypnotics , 45 percent vs. 21 percent . In the experimental nursing homes residents who were initially taking antipsychotic drugs showed less deterioration on several measures of cognitive function than similar residents in the control facilities , but they were more likely to report depression . Those who were initially taking benzodiazepines or antihistamine hypnotic agents reported less anxiety than controls but had more loss of memory . Most other measures of clinical status remained unchanged in both groups . CONCLUSIONS An educational program targeted to physicians , nurses , and aides can reduce the use of psychoactive drugs in nursing homes without adversely affecting the overall behavior and level of functioning of the residents The objectives of this r and omized clinical trial were to investigate the impact of the discontinuation of long-term antipsychotics in residents with dementia in chronic care institutions and to identify clinical predictors of safe discontinuation . Subjects included 34 residents with dementia who were on antipsychotics for more than 6 months and whose behavior was currently stable . Subjects were r and omized to either continue receiving their regular dosage of antipsychotics or to receive placebo for 6 months . Early withdrawal from the study was not statistically different between the groups ( relative risk [ RR ] = 1.57 , 95 % confidence interval [ CI ] 0.76 - 3.26 ) , and though not significantly different , subjects in the placebo group were more likely to be withdrawn from the study because of worsening behavior ( RR = 1.25 , 95 % Cl 0.33 - 4.76 ) . Three subjects in the placebo group were withdrawn from the study due to worsening of extrapyramidal symptoms . The active treatment group had more behavioral problems ( e.g. , physical aggression towards others , p < .05 ) compared to the placebo group . The placebo group developed more apathy , but balancing this outcome was a relative improvement in cognitive functioning . Baseline antipsychotic dose was predictive of behavioral worsening upon discontinuation of long-term antipsychotic drugs . The primary limitation of the study was the small sample size . In conclusion , a trial of discontinuation of antipsychotics should be considered in this population BACKGROUND We report the findings from the first large , double-blind , placebo-controlled study conducted to evaluate the efficacy and safety of risperidone in the treatment of psychotic and behavioral symptoms in institutionalized elderly patients with dementia . METHOD 625 patients ( 67.8 % women ; mean age = 82.7 years ) with DSM-IV diagnoses of Alzheimer 's disease ( 73 % ) , vascular dementia ( 15 % ) , or mixed dementia ( 12 % ) and significant psychotic and behavioral symptoms were included . Each patient was r and omly assigned to receive placebo or 0.5 mg/day , 1 mg/day , or 2 mg/day of risperidone for 12 weeks . The primary outcome measure was the Behavioral Pathology in Alzheimer 's Disease rating scale ( BEHAVE-AD ) . RESULTS The study was completed by 70 % of the patients . Baseline Functional Assessment Staging scores were 6 or 7 in more than 95 % of the patients , indicating severe dementia . At endpoint , significantly greater reductions in BEHAVE-AD total scores and psychosis and aggressiveness subscale scores were seen in patients receiving 1 and 2 mg/day of risperidone than in placebo patients ( p = .005 and p < .001 , respectively ) . At week 12 , 0.5 mg/day of risperidone was superior to placebo in reducing BEHAVE-AD aggression scores ( p = .02 ) . More adverse events were reported by patients receiving 2 mg/day of risperidone than 1 mg/day . The most common dose-related adverse events were extrapyramidal symptoms , somnolence , and mild peripheral edema . The frequency of extrapyramidal symptoms in patients receiving 1 mg/day of risperidone was not significantly greater than in placebo patients . CONCLUSION Risperidone significantly improved symptoms of psychosis and aggressive behavior in patients with severe dementia . Results show that 1 mg/day of risperidone is an appropriate dose for most elderly patients with dementia This double-blind study investigated the efficacy and safety of rapid-acting intramuscular olanzapine in treating agitation associated with Alzheimer 's disease and /or vascular dementia . At 2 h , olanzapine ( 5.0 mg , 2.5 mg ) and lorazepam ( 1.0 mg ) showed significant improvement over placebo on the PANSS Excited Component ( PANSS-EC ) and Agitation – Calmness Evaluation Scale ( ACES ) , and both 5.0 mg olanzapine and lorazepam showed superiority to placebo on the Cohen-Mansfield Agitation Inventory . At 24 h , both olanzapine groups maintained superiority over placebo on the PANSS-EC ;  lorazepam did not . Olanzapine ( 5.0 mg ) and lorazepam  improved ACES scores more than placebo . Simpson – Angus and Mini-Mental State Examination scores did not change significantly from baseline . Sedation ( ACES ⩾8 ) , adverse events , and laboratory analytes were not significantly different from placebo for any treatment . No significant differences among treatment groups were seen in extrapyramidal symptoms or in corrected QT interval at either 2 h or 24 h , and no significant differences among treatment groups were seen in vital signs , including orthostasis . Intramuscular injection of olanzapine may therefore provide substantial benefit in rapidly treating in patients with acute dementia-related agitation BACKGROUND Patients with Alzheimer disease ( AD ) commonly exhibit psychosis and behavioral disturbances that impair patient functioning , create caregiver distress , and lead to institutionalization . This study was conducted to assess the efficacy and safety of olanzapine in treating psychosis and /or agitation/aggression in patients with AD . METHODS A multicenter , double-blind , placebo-controlled , 6-week study was conducted in 206 elderly US nursing home residents with AD who exhibited psychotic and /or behavioral symptoms . Patients were r and omly assigned to placebo or a fixed dose of 5 , 10 , or 15 mg/d of olanzapine . The primary efficacy measure was the sum of the Agitation/Aggression , Hallucinations , and Delusions items ( Core Total ) of the Neuropsychiatric Inventory-Nursing Home version . RESULTS Low-dose olanzapine ( 5 and 10 mg/d ) produced significant improvement compared with placebo on the Core Total ( -7.6 vs -3.7 [ P<.001 ] and -6.1 vs -3 . 7 [ P = .006 ] , respectively ) . Core Total improvement with olanzapine , 15 mg/d , was not significantly greater than placebo . The Occupational Disruptiveness score , reflecting the impact of patients ' psychosis and behavioral disturbances on the caregiver , was significantly reduced in the 5-mg/d olanzapine group compared with placebo ( -2.7 vs -1.5 ; P = .008 ) . Somnolence was significantly more common among patients receiving olanzapine ( 25.0%-35.8 % ) , and gait disturbance occurred in those receiving 5 or 15 mg/d ( 19.6 % and 17.0 % , respectively ) . No significant cognitive impairment , increase in extrapyramidal symptoms , or central anticholinergic effects were found at any olanzapine dose relative to placebo . CONCLUSION Low-dose olanzapine ( 5 and 10 mg/d ) was significantly superior to placebo and well tolerated in treating agitation/aggression and psychosis in this population of patients with AD OBJECTIVE The association of hyperglycemia and hypercholesterolemia with use of atypical antipsychotics has been documented in case reports and uncontrolled studies . The authors ' goal was to assess the effects of clozapine , olanzapine , risperidone , and haloperidol on glucose and ch 
    Output:
    
Adverse events were common and included extrapyramidal symptoms , somnolence , and abnormal gait .
Limited evidence supports the perception of improved efficacy and adverse event profiles compared with typical antipsychotic drugs