Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014

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Abstract
The behavioral and psychological symptoms of dementia are found in patients with all types and stages of dementia and occur in clusters or syndromes such as psychosis (delusions and hallucinations), agitation, aggression, and disinhibition.1-3 Nonpharmacologic interventions—better stated as behavioral and environmental interventions—are recommended by numerous guidelines, medical organizations, and expert groups as the preferred first-line treatment,4-7 although they have largely not been translated into routine clinical practice.8 Despite the fact that no drugs have been approved by the US Food and Drug Administration (FDA) for the behavioral and psychological symptoms of dementia, the current mainstay of treatment is the off-label use of psychotropic medications.9,10 Of such agents, atypical antipsychotics have the strongest base of evidence, although their benefits are moderate at best and they are associated with a significant increase in the risk of stroke and mortality.11,12 Given the concerns regarding mortality, the FDA issued black box warnings for atypical antipsychotics in 2005 and for conventional antipsychotics in 2008.

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