Schneider LS etr al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. NEJM 2006; 355:1533-1538.
Design 421 patients with average MMSE 15 enrolled at 42 sites. Subjects were randomized to placebo, 5.5 mg/d olanzepine, 1 mg/day risperidone, or 56.5 mg/day of quetiapine. Endpoint was the time until the physician switched the medication. Results were not significantly different in the various groups except on minor measures. AE's included higher eps in patients receiving risperidone or olanzepine, and sedation with olanzepine and quetiapine (more than risperidone). Cognitive disturbances were higher in patients on olanzepine (7%) and increased agitation in those getting quetiapine.
In Neurology Alert, Norman Relkin comments that treatment of psychosis in AL is not a matter of writing a drug, but looking at all drugs, precipitants, sleep wake cycle and nutrition, supportive environment and caregiver education, none of which were controlled for. The study did not show the antipsychotic drugs were ineffective, just that they have risks as well. The lay press has misinterpreted the results.