Impact de la diminution des neuroleptiques sur les troubles du comportement en gériatrie

Neuroleptics are often prescribed to treat elderly patients with behavioral disorders, although antipsychotics are associated with unfavorable outcomes in this population. The aim of this study was to evaluate the impact of a decrease in neuroleptics on behavioral disorders among hospitalized elderly patients. A multicenter prospective observational study was conducted (5 University hospitals in Paris) including patients over 70 years treated with neuroleptics for behavioral disorders. At day 0, the participants were classified into 2 populations on the basis of the opinions of their physicians and the Neuropsychiatric Inventory (NPI-ES) score. Group 1 included patients whose neuroleptic treatment was maintained at the same dosage and Group 2 included patients whose neuroleptic treatment was decreased. The evolution of behavioral disorders was assessed at day 8 from the NPI-ES score. The Clinical Global Impression (CGI) was also scored by physicians and nurses at D0 and D8. Seventy-eight patients (mean age ± SD: 81.5 years + 5.7 years) presenting psychiatric illnesses (15.4%) or dementia (84.6%) alongside behavioral disorders (NPI-ES (mean ± SD): 26.06 ± 23.31/144) were included: 40 patients in Group 1 and 38 in Group 2. The decrease in neuroleptics was associated with a significant decrease in the severity of the behavioral disorders in Group 2 at day 8 compared to patients in Group 1 who had remained on the same dosages, after adjustment on the severity of disorders at day 0 (ΔNPI-ES: Group 1 vs. Group 2 = −0,13 vs. −0,34, p = 0.003). The mean ΔCGI showed agreement between physicians and nurses and the variation was in line with that of the mean ΔNPI-ES. This study has thus evidenced an association between the decrease of neuroleptic dose and the decrease in behavioral disorders assessed on the NPI-ES at day 8. This result supports recommendations to regularly review neuroleptic prescriptions in order to determine whether these treatments are appropriate.