***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: OBJECTIVES The objectives of this study were to evaluate the efficacy , safety , and tolerability of quetiapine for treating psychosis in patients with probable/possible Alzheimer disease and assess its impact on other psychopathology and social and daily functioning . METHOD The authors conducted a multicenter , double-blind , placebo-controlled , r and omized trial of flexibly dosed quetiapine and haloperidol . Primary outcomes were change in total Brief Psychiatric Rating Scale ( BPRS ) and Clinical Global Impressions-Severity of Illness ( CGI-S ) scores at week 10 . Secondary outcomes included BPRS factors , Neuropsychiatric Inventory ( NPI ) , Multidimensional Observation Scale for Elderly Subjects ( MOSES ) , and Physical Self-Maintenance Scale ( PSMS ) . RESULTS Two hundred eighty-four participants ( mean age : 83.2 years ) were r and omized ; 63.4 % completed ; and mean Mini-Mental State Examination score was 12.8 . Median of the mean daily dose was 96.9 mg for quetiapine and 1.9 mg for haloperidol . No differential benefit was seen on any psychosis measure . BPRS agitation factor scores improved with quetiapine versus placebo and not quetiapine versus haloperidol .  BPRS anergia scores worsened with haloperidol versus quetiapine but not quetiapine versus placebo . No NPI factors showed change , including the agitation factor . MOSES Withdrawal Subscale and PSMS total scores worsened with haloperidol versus quetiapine .  Somnolence occurred in 25.3 % , 36.2 % , and 4.1 % of the quetiapine , haloperidol , and placebo groups , respectively ; parkinsonism was most prevalent in the haloperidol group ; other safety and tolerability measures differed little among groups . CONCLUSION All treatment groups showed improvement in measures of psychosis without significant differences between them when planned comparisons were performed . Participants treated with quetiapine or haloperidol showed inconsistent evidence of improvement in agitation . Tolerability was better with quetiapine compared with haloperidol SETTING Treating elderly patients with Alzheimer 's disease ( AD ) and behavioral and psychological symptoms of dementia ( BPSD ) is challenging due to the increased risk of iatrogenic movement disorders with old neuroleptics and the seemingly increasing risk of cardiovascular events with newer atypical agents . Quetiapine is an atypical antipsychotic agent that warrants further investigation . OBJECTIVES To assess tolerability , safety , and clinical benefit of quetiapine in AD patients with BPSD . PARTICIPANTS AND DESIGN AD patients with BPSD participated in a 6-week r and omized , double-blind , placebo-controlled trial . Quetiapine was increased on the basis of clinical response and tolerability . Primary efficacy assessment s included the Neuropsychiatric Inventory ( NPI ) and Clinical Global Impression of Change ( CGI-C ) . Secondary efficacy measures included the Mini-Mental State Examination ( MMSE ) , the Simpson-Angus Scale ( SAS ) and the Abnormal Involuntary Movement Scale ( AIMS ) . RESULTS Forty patients ( 26 women ) , mean age 82.2 ( SD 6.4 ) years were enrolled , 27 completed treatment . Median dose of quetiapine was 200 mg/day . Significant NPI total scores reductions ( 79 % for placebo and 68.5 % for quetiapine ) were observed . The CGI-C score decreased significantly in the quetiapine group ( p = 0.009 at 6 weeks ) and did not change significantly in the placebo group ( p = 0.48 ) . The MMSE , AIMS , SAS scores and adverse events did not differ significantly between the two arms . CONCLUSIONS Quetiapine did not significantly improve psychosis scores . It did not cause cognitive and motor deterioration . These results might possibly be due to small sample size BACKGROUND Despite modest efficacy , unpredictable individual utility , and a high rate of adverse effects , behavioural and psychological symptoms of dementia ( BPSD ) are common determinants for antipsychotic drug therapy in nursing home patients . AIMS To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia . METHODS Fifty-five patients ( 43 women ; mean age 84.1 ) taking haloperidol , risperidone , or olanzapine for BPSD were r and omly assigned to cessation ( intervention group , n=27 ) or continued treatment with antipsychotic drugs ( reference group , n=28 ) for 4 consecutive weeks . The Neuropsychiatric Inventory ( NPI ) Question naire was used to examine changes in behavioural and psychological symptoms . RESULTS By study completion , 23 of the 27 intervention group patients were still off antipsychotics . Symptom scores ( NPI ) remained stable or even improved in 42 patients ( intervention group , 18 out of 27 ; reference group , 24 out of 28 ; p=0.18 ) . As compared to patients with stable or improved symptom scores , patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline ( p=0.42 ) . CONCLUSION A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD , do well without this treatment . St and ardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals OBJECTIVE To compare citalopram and risperidone for the treatment of psychotic symptoms and agitation associated with dementia , with a priori hypotheses that risperidone would be more efficacious for psychosis and citalopram for agitation . METHODS A 12-week r and omized , controlled trial in nondepressed patients with dementia hospitalized because of behavioral symptoms ( N = 103 ) was conducted at the University of Pittsburgh Medical Center . Participants were consecutively recruited on an inpatient unit if they had at least one moderate to severe target symptom ( aggression , agitation , hostility , suspiciousness , hallucinations , or delusions ) . Once they improved sufficiently , they were discharged to nursing homes , personal care homes , or residential homes for continued treatment . Planned pre-post and mixed model analyses of the main outcome measures of Neurobehavioral Rating Scale and Side Effect Rating Scale at baseline and at weekly/biweekly intervals were conducted . RESULTS Completion rates did not differ for citalopram and risperidone ( overall completion rate : 44 % ) . Agitation symptoms ( aggression , agitation , or hostility ) and psychotic symptoms ( suspiciousness , hallucinations , or delusions ) decreased in both treatment groups but the improvement did not differ significantly between the two groups . There was a significant increase in side effect burden with risperidone but not with citalopram such that the two groups differed significantly . CONCLUSION No statistical difference was found in the efficacy of citalopram and risperidone for the treatment of either agitation or psychotic symptoms in patients with dementia . These findings need to be replicated before citalopram or other serotonergic antidepressants can be recommended as alternatives to antipsychotics for the treatment of agitation or psychotic symptoms associated with dementia BACKGROUND Second-generation ( atypical ) antipsychotic drugs are widely used to treat psychosis , aggression , and agitation in patients with Alzheimer 's disease , but their benefits are uncertain and concerns about safety have emerged . We assessed the effectiveness of atypical antipsychotic drugs in out patients with Alzheimer 's disease . METHODS In this 42-site , double-blind , placebo-controlled trial , 421 out patients with Alzheimer 's disease and psychosis , aggression , or agitation were r and omly assigned to receive olanzapine ( mean dose , 5.5 mg per day ) , quetiapine ( mean dose , 56.5 mg per day ) , risperidone ( mean dose , 1.0 mg per day ) , or placebo . Doses were adjusted as needed , and patients were followed for up to 36 weeks . The main outcomes were the time from initial treatment to the discontinuation of treatment for any reason and the number of patients with at least minimal improvement on the Clinical Global Impression of Change ( CGIC ) scale at 12 weeks . RESULTS There were no significant differences among treatments with regard to the time to the discontinuation of treatment for any reason : olanzapine ( median , 8.1 weeks ) , quetiapine ( median , 5.3 weeks ) , risperidone ( median , 7.4 weeks ) , and placebo ( median , 8.0 weeks ) ( P=0.52 ) . The median time to the discontinuation of treatment due to a lack of efficacy favored olanzapine ( 22.1 weeks ) and risperidone ( 26.7 weeks ) as compared with quetiapine ( 9.1 weeks ) and placebo ( 9.0 weeks ) ( P=0.002 ) . The time to the discontinuation of treatment due to adverse events or intolerability favored placebo . Overall , 24 % of patients who received olanzapine , 16 % of patients who received quetiapine , 18 % of patients who received risperidone , and 5 % of patients who received placebo discontinued their assigned treatment owing to intolerability ( P=0.009 ) . No significant differences were noted among the groups with regard to improvement on the CGIC scale . Improvement was observed in 32 % of patients assigned to olanzapine , 26 % of patients assigned to quetiapine , 29 % of patients assigned to risperidone , and 21 % of patients assigned to placebo ( P=0.22 ) . CONCLUSIONS Adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis , aggression , or agitation in patients with Alzheimer 's disease . ( Clinical Trials.gov number , NCT00015548 [ Clinical Trials.gov ] . ) Background There have been increasing concerns regarding the safety and efficacy of neuroleptics in people with dementia , but there are very few long-term trials to inform clinical practice . The aim of this study was to determine the impact of long-term treatment with neuroleptic agents upon global cognitive decline and neuropsychiatric symptoms in patients with Alzheimer disease . Methods and Findings Design : R and omised , blinded , placebo-controlled parallel two-group treatment discontinuation trial . Setting : Oxfordshire , Newcastle and Gateshead , London and Edinburgh , United Kingdom . Participants : Patients currently prescribed the neuroleptics thioridazine , chlorpromazine , haloperidol trifluoperazine or risperidone for behavioural or psychiatric disturbance in dementia for at least 3 mo . Interventions : Continue neuroleptic treatment for 12 mo or switch to an identical placebo . Outcome measures : Primary outcome was total Severe Impairment Battery ( SIB ) score . Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory ( NPI ) . Results : 165 patients were r and omised ( 83 to continue treatment and 82 to placebo , i.e. , discontinue treatment ) , of whom 128 ( 78 % ) commenced treatment ( 64 continue/64 placebo ) . Of those , 26 were lost to follow-up ( 13 per arm ) , result ing in 51 patients per arm analysed for the primary outcome . There was no significant difference between the continue treatment and placebo groups in the estimated mean change in SIB scores between baseline and 6 mo ; estimated mean difference in deterioration ( favouring placebo ) −0.4 ( 95 % confidence interval [ CI ] −6.4 to 5.5 ) , adjusted for baseline value ( p = 0.9 ) . For neuropsychiatric symptoms , there was no significant difference between the continue treatment and placebo groups ( n = 56 and 53 , respectively ) in the estimated mean change in NPI scores between baseline and 6 mo ; estimated mean difference in deterioration ( favouring continue treatment ) −2.4 ( 95 % CI −8.2 to 3.5 ) , adjusted for baseline value ( p = 0.4 ) . Both results became more pronounced at 12 mo . There was some evidence to suggest that those patients with initial NPI ≥ 15 benefited on neuropsychiatric symptoms from continuing treatment . Conclusions For most patients with AD , withdrawal of neuroleptics had no overall detrimental effect on functional and cognitive status .  Neuroleptics may have some value in the maintenance treatment of more severe neuropsychiatric symptoms , but this benefit must be weighed against the side effects of therapy . Trial registration : Cochrane Central Registry of Controlled Trials/National Research Register ( # IS RCT N33368770 ) OBJECTIVE In this study we directly compared the efficacy and tolerability of the atypical antipsychotics quetiapine and risperidone in elderly patients with dementia and symptoms of disturbed perception , thought content , mood or behaviour ( behavioural and psychological symptoms of dementia-BPSD ) . METHODS We conducted an 8-week , rater-blinded , r and omised study of 72 out patients ( 55 - 85 years ) with BPSD ( assessed by NPI baseline score ) , who received flexibly-dosed quetiapine ( 50 - 400 mg/day ) or risperidone ( 0.5 - 2 mg/day ) . Primary efficacy measure : Neuropsychiatric Inventory ( NPI ) Parts 1 and 2 ; secondary efficacy measures : Clinical Global Impression ( CGI ) , C 
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Moreover , studies conducted with similar method ological design show conflicting efficacy results .
Conclusions Because of their undemonstrated effectiveness , SGAs should be avoided in patients with dementia complicated by psychotic and /or behavioural symptoms .