The use of benzodiazepines in the management of behavioral symptoms in demented patients.

Hard data on the efficacy of benzodiazepines in the treatment of behavioral disturbances in Alzheimer's disease are not available. Short-acting benzodiazepines, such as oxazepam, appear safer than long-acting benzodiazepines and more efficient than placebo in the short-term (4-8 weeks) treatment of behavioral disturbances in geriatric, psychogeriatric, and demented patients. It is unknown whether oxazepam is superior to neuroleptic drugs or other commonly prescribed sedatives in this context. To some extent these findings may apply to patients with Alzheimer's disease as well, but there are several arguments against an uncritical extrapolation of conclusions drawn from other geriatric populations to patients with Alzheimer's disease. When, despite the lack of well-founded knowledge in this field, such a treatment modality is chosen, short-acting benzodiazepines should be preferred over long-acting agents. Drug interactions and pharmacokinetic aspects of the specific agent in the individual patient should always be considered carefully. Future studies on the treatment of behavioral disturbances in Alzheimer's disease need to clarify which specific behavioral symptoms should be treated pharmacologically, which therapeutic agents have the most advantageous risk-benefit ratio in this context, and what is the optimal treatment duration.

Cholinergic strategies in the treatment of Alzheimer's disease.

Since the identification of the cholinergic deficit, strategies aimed at enhancing cholinergic neurotransmission have dominated the field of pharmacology in Alzheimer's disease (AD). These strategies include increasing acetylcholine precursor availability, delaying synaptic degradation and stimulating muscarinic receptors. Although most clinical trials report mild symptomatic improvements in some patients, support for large-scale clinical use of cholinomimetics in AD is not yet available. This article presents the most representative clinical trials, discusses the limitations of the cholinergic strategies and suggests future directions in the treatment of AD.