Findings link behavioral and psychological symptoms of dementia (BPSD) with early stages of Alzheimer’s disease (AD) pathogenesis and greater amyloid deposition, suggesting that these symptoms are core expressions of the neurodegenerative process rather than secondary responses. Understanding the neuropathology of BPSD in AD is crucial for developing effective treatments. Transgenic animal models exhibiting amyloid and tau pathologies provide insights into early behavioral symptoms in AD, aiding in identifying new pharmacological targets for specific BPSD like aggression and agitation.

Brexpiprazole, a partial agonist and antagonist at various receptors, has shown efficacy and tolerability for treating agitation in AD. Pimavanserin, a 5-HT2A receptor antagonist, approved for Parkinson’s disease psychosis, is showing potential in AD-related psychosis. These developments indicate a shift toward more effective, safer treatments for BPSD in AD, though long-term safety and efficacy studies are necessary.

Reference: Caraci F, Santagati M, Caruso G, et al. New antipsychotic drugs for the treatment of agitation and psychosis in Alzheimer’s disease: focus on brexpiprazole and pimavanserin. F1000Res. 2020;9:F1000 Faculty Rev-686. doi: 10.12688/f1000research.22662.1.