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Cognitive effects of atypical antipsychotic medications in patients with Alzheimer’s disease: outcomes from CATIE-AD


Vigen, Cheryl L. P., Mack, Wendy J., Keefe, Richard S. E., Sano, Mary, Sultzer, David L., Stroup, T. Scott, Dagerman, Karen S., Hsiao, John K., Lebowitz, Barry D., Lyketsos, Constantine G., Tariot, Pierre N., Zheng, Ling, Schneider, Lon S.


The American Journal Of Psychiatry, Volume: 168, No.: 8, Pages.: 831-839

Year of Publication



Objective: The impact of the atypical antipsychotics olanzapine, quetiapine, and risperidone on cognition in patients with Alzheimer’s disease is unclear. The authors assessed the effects of time and treatment on neuropsychological functioning during the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer’s Disease study (CATIE-AD).; Method: CATIE-AD included 421 outpatients with Alzheimer’s disease and psychosis or agitated/aggressive behavior who were randomly assigned to receive masked, flexible-dose olanzapine, quetiapine, risperidone, or placebo. Based on their clinicians’ judgment, patients could discontinue the originally assigned medication and receive another randomly assigned medication. Patients were followed for 36 weeks, and cognitive assessments were obtained at baseline and at 12, 24, and 36 weeks. Outcomes were compared for 357 patients for whom data were available for at least one cognitive measure at baseline and one follow-up assessment that took place after they had been on their prescribed medication or placebo for at least 2 weeks.; Results: Overall, patients showed steady, significant declines over time in most cognitive areas, including in scores on the Mini-Mental State Examination (MMSE; -2.4 points over 36 weeks) and the cognitive subscale of the Alzheimer’s Disease Assessment Scale (-4.4 points). Cognitive function declined more in patients receiving antipsychotics than in those given placebo on multiple cognitive measures, including the MMSE, the cognitive subscale of the Brief Psychiatric Rating Scale, and a cognitive summary score summarizing change on 18 cognitive tests.; Conclusions: In CATIE-AD, atypical antipsychotics were associated with worsening cognitive function at a magnitude consistent with 1 year’s deterioration compared with placebo. Further cognitive impairment is an additional risk of treatment with atypical antipsychotics that should be considered when treating patients with Alzheimer’s disease.;

Bibtex Citation

@article{Vigen_2011, doi = {10.1176/appi.ajp.2011.08121844}, url = {}, year = 2011, month = {aug}, publisher = {American Psychiatric Publishing}, volume = {168}, number = {8}, pages = {831--839}, author = {Cheryl L.P. Vigen and Wendy J. Mack and Richard S.E. Keefe and Mary Sano and David L. Sultzer and T. Scott Stroup and Karen S. Dagerman and John K. Hsiao and Barry D. Lebowitz and Constantine G. Lyketsos and Pierre N. Tariot and Ling Zheng and Lon S. Schneider}, title = {Cognitive Effects of Atypical Antipsychotic Medications in Patients With Alzheimer{textquotesingle}s Disease: Outcomes From {CATIE}-{AD}}, journal = {American Journal of Psychiatry} }


activities of daily living, adverse effects, aged, aged, 80 and over, alzheimer disease, antipsychotic agents, benzodiazepines, chemically induced, classification, cognition disorders, diagnosis, dibenzothiazepines, disease progression, double-blind method, drug substitution, drug therapy, female, humans, male, mental status schedule, neuropsychological tests, olanzapine, patient dropouts, psychology, risperidone, statistics & numerical data, therapeutic use

Countries of Study


Types of Dementia

Alzheimer’s Disease

Types of Study

Randomised Controlled Trial

Type of Outcomes

Behaviour, Cognition

Type of Interventions

Pharmaceutical Interventions

Pharmaceutical Interventions

Antipsychotics and antidepressants