The Effects of Olanzapine in Reducing the Emergence of Psychosis Among Nursing Home Patients With Alzheimer's Disease

Background: Elderly patients with Alzheimer’sdisease (AD) commonly exhibit psychotic symptoms, promptingclinicians to administer antipsychotics. This article comparesthe effects of olanzapine and placebo in the emergence ofhallucinations or delusions in AD patients with symptoms ofagitation/aggression but little or no psychotic symptomatology atbaseline.

Method: A multicenter, double-blind,placebo-controlled study was conducted in nursing home patientswith AD according to DSM-IV criteria and symptoms ofagitation/aggression and/or psychosis. Patients (N = 206) wererandomly assigned to receive either placebo or fixed-doseolanzapine (5, 10, or 15 mg/day) for up to 6 weeks. This articleanalyzes data from a subgroup of patients (N = 165) with no orminimal delusions and/or hallucinations at baseline as measuredby the Neuropsychiatric Inventory-Nursing Home Version (NPI/NH).Three subsets of patients were identified on the basis of theirsymptoms at baseline: those with no clinically significanthallucinations, those with no clinically significant delusions,and those with no clinically significant delusions orhallucinations.

Results: Of the patients without hallucinationsor delusions at baseline (N = 75), the placebo-treated patientsshowed significantly greater development of these symptomscompared with olanzapine-treated patients overall (NPI/NHhallucinations + delusions mean change score, +2.73 vs. +0.27, p= .006). Similarly, of the patients without baselinehallucinations (N = 153), the placebo-treated patients showedgreater hallucinations score increases than didolanzapine-treated patients overall (+1.25 vs. +0.33, p = .026),whereas patients without baseline delusions (N = 87) showed nosignificant treatment effects. Olanzapine had a favorable safetyprofile in each patient subset.

Conclusion: These results suggest that, overall,olanzapine effectively attenuated emergence of psychosis in ashort-term trial of patients with Alzheimer’s disease.