Skip to main content Accessibility help

Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings

  • Maria Gustafsson (a1), Per-Olof Sandman (a2), Stig Karlsson (a3), Yngve Gustafson (a4) and Hugo Lövheim (a4)...



Behavioral and psychological symptoms are common among cognitively impaired individuals and psychotropic drugs are widely used for their treatment. The aim of this study was to describe the prevalence and associated factors of psychotropic and anti-dementia drug use among old people with cognitive impairment living in geriatric care settings.


The study comprised 2,019 cognitively impaired people living in geriatric care units in the county of Västerbotten, Sweden. Data concerning psychotropic and anti-dementia drug use, function in activities of daily living, cognitive function, and prevalence of behavioral and psychological symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale.


Of the study population, 1,442 individuals (71%) were prescribed at least one psychotropic drug (antidepressants (49%), anxiolytics, hypnotics, and sedatives (36%), antipsychotics (25%)). Furthermore, 363 individuals (18%) received anti-dementia drugs. Associations between various behavioral and psychological symptoms were found for all psychotropic drug classes and anti-dementia drugs. Verbally disruptive/attention-seeking behavior was associated with all psychotropic drugs. Use of antipsychotics was associated with several behavioral and psychological symptoms, including aggressive behavior.


The associations between behavioral and psychological symptoms and psychotropic drug use found in this study indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals despite limited evidence of their efficacy. Given the significant risk of adverse effects among old people with cognitive impairment, it is important to ensure that any medication used is both appropriate and safe.


Corresponding author

Correspondence should be addressed to: Maria Gustafsson, MSc Pharm, Department of Pharmacology and Clinical Neurosciences, Umeå University, Umeå SE-901 85, Sweden. Phone: +46-90-785-35-62; Fax: +46-90-12-04-30. Email:


Hide All
Adolfsson, R., Gottfries, C. G., Nyström, L. and Winblad, B. (1981). Prevalence of dementia disorders in institutionalized Swedish old people. The workload imposed by caring for these patients. Acta Psychiatrica Scandinavica, 63, 225244.
Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18, 249255.
Ballard, C. G., Waite, J. and Birks, J. (2006). Atypical antipsychotics for aggression and psychosis in Alzheimer's disease. Cochrane Database of Systematic Reviews, CD003476 doi:10.1002/14651858.CD003476.pub2.
Ballard, al. (2005). Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. BMJ, 330, 874. doi:10.1136/bmj.38369.459988.8F.
Banerjee, al. (2011). Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet, 378, 403411. doi:10.1016/S0140-6736(11)60830-1.
Cancelli, I., Beltrame, M., Gigli, G. L. and Valente, M. (2009). Drugs with anticholinergic properties: cognitive and neuropsychiatric side-effects in elderly patients. Neurological Sciences, 30, 8792. doi:10.1007/s10072-009-0033-y.
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, s.73. doi:10.3389/fneur.2012.00073.
Chiu, M.-J., Chen, T.-F., Yip, P.-K., Hua, M.-S. and Tang, L.-Y. (2006). Behavioral and psychologic symptoms in different types of dementia. Journal of the Formosan Medical Association, 105, 556562.
Gauthier, al. (2010). Management of behavioral problems in Alzheimer's disease. International Psychogeriatrics, 22, 346372. doi:10.1017/S1041610209991505.
Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A. and Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331, 1169. doi:10.1136/bmj.38623.768588.47.
Gustafsson, M., Karlsson, S. and Lövheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology & Toxicology, 14, s.10.
Henry, G., Williamson, D. and Tampi, R. R. (2011). Efficacy and tolerability of antidepressants in the treatment of behavioral and psychological symptoms of dementia, a literature review of evidence. American Journal of Alzheimer's Disease and Other Dementias, 26, 169183. doi:10.1177/1533317511402051.
Lanctôt, K. L., Herrmann, N., van Reekum, R., Eryavec, G. and Naranjo, C. A. (2002). Gender, aggression and serotonergic function are associated with response to sertraline for behavioral disturbances in Alzheimer's disease. International Journal of Geriatric Psychiatry, 17, 531541. doi:10.1002/gps.636.
Lövheim, H., Sandman, P.-O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713726. doi:10.1017/S1041610206003930.
Lövheim, H., Sandman, P.-O., Karlsson, S. and Gustafson, Y. (2008). Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment. International Psychogeriatrics, 20, 777789. doi:10.1017/S1041610208006777.
Medical Products Agency. (2008). Läkemedelsverkets behandlingsrekommendationer: Läkemedelsbehandling och bemötande vid Beteendemässiga och Psykiska Symtom vid Demenssjukdom – BPSD. Information från läkemedelsverket (2547). Läkemedelsverket: Stockholm, Sweden (in Swedish).
Nijk, R. M., Zuidema, S. U. and Koopmans, R. T. C. M. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics, 21, 485493. doi:10.1017/S1041610209008916.
O’Connor, D. W., Ames, D., Gardner, B. and King, M. (2009). Psychosocial treatments of psychological symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, 21, 241251. doi:10.1017/S1041610208008223,
Pollock, B. al. (2002). Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. The American Journal of Psychiatry, 159, 460465.
Pollock, B. al. (2007). A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. The American Journal of Geriatric Psychiatry, 15, 942952.
Ruths, S., Straand, J., Nygaard, H. A. and Aarsland, D. (2008). Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study – the Bergen District Nursing Home Study (BEDNURS). International Journal of Geriatric Psychiatry, 23, 889895. doi:10.1002/gps.1998.
Sandman, P. O., Adolfsson, R., Norberg, A., Nyström, L. and Winblad, B. (1988). Long-term care of the elderly. a descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden. Comprehensive Gerontology. Section A, Clinical and Laboratory Sciences, 2, 120132.
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 19341943. doi:10.1001/jama.294.15.1934.
Schneider, L. al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. The New England Journal of Medicine, 355, 15251538. doi:10.1056/NEJMoa061240.
Selbaek, G., Kirkevold, Ø. and Engedal, K. (2008). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes – a 12-month follow-up study. The American Journal of Geriatric Psychiatry, 16, 528536.
Statistics Sweden. (2010). Population Statistics. Örebro, Sweden: Statistics Sweden.
Tariot, P. N., Farlow, M. R., Grossberg, G. T., Graham, S. M., McDonald, S. and Gergel, I. (2004). Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA, 291, 317324. doi:10.1001/jama.291.3.317.
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2011). Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. International Psychogeriatrics, 23, 16321639. doi:10.1017/S1041610211001438.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed