DRUG-BASED INTERVENTIONS FOR AGGRESSION IN DEMENTIA: CURRENT INSIGHTS AND FUTURE PROSPECTS

Dementia is a debilitating neurodegenerative condition affecting millions worldwide, marked not only by cognitive decline but also by Behavioral and Psychological Symptoms of Dementia (BPSD), with aggression being one of the most disruptive manifestations. Aggressive behavior in dementia contributes significantly to caregiver burden, early institutionalization, patient morbidity, and increased healthcare utilization. Although nonpharmacological approaches are preferred as first-line treatments, pharmacological interventions—particularly antipsychotics—are often employed when the patient poses a risk to themselves or others. This literature review examines the pharmacological management of aggression in dementia, emphasizing the role, effectiveness, and safety of antipsychotics. The review outlines the neurobiological underpinnings of aggression, including alterations in neurotransmitter pathways—dopaminergic, serotonergic, and cholinergic—and functional disruptions in brain regions associated with impulse control and emotional regulation. Both typical and atypical antipsychotics are analyzed, with particular attention to agents like risperidone and olanzapine, which show modest efficacy in mitigating aggression. Despite their clinical utility, antipsychotics carry considerable risk, especially for elderly patients. Adverse effects include extrapyramidal symptoms, sedation, metabolic syndrome, increased incidence of cerebrovascular events, and heightened mortality. These concerns have led to regulatory warnings from agencies such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA), recommending cautious, case-by-case prescription. In light of these risks, this review also evaluates alternative pharmacological options, including selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and anticonvulsants. Additionally, the paper highlights promising research into novel therapeutic agents and personalized medicine approaches that may offer safer and more targeted solutions. Given the complexity and ethical implications of prescribing antipsychotics in dementia, an individualized, evidence-based, and multidisciplinary approach is essential. Future research should prioritize drug safety, efficacy, and integration with nonpharmacological strategies to improve outcomes for both patients and caregivers.