Psychotropic drugs—such as antipsychotics, antidepressants, and sedatives—are sometimes prescribed to individuals living with dementia to manage behavioral symptoms. However, these medications carry serious risks and are not the most effective or appropriate response. This page includes resources to help families, caregivers, and professionals understand the potential harms, explore safer alternatives, and make informed decisions about medication use.

Resources

A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care. (2024). Leme, D. E. C., Mathias, K., Mofina, A., Liperoti, R., Betini, G. S., & Hirdes, J. P. Journal of the American Medical Directors Association, 25(11), 105255. Available at https://doi.org/10.1016/j.jamda.2024.105255.

  • This study investigates the impact of antipsychotic medications on the worsening of behavioral symptoms in long-term care (LTC) residents with mild to moderate symptoms. Using data from residents in Canada, the study found a significant association between antipsychotic use at baseline and an increase in behavioral symptoms, such as agitation and aggression, at follow-up.

Antipsychotic Drug List. (2023). The Long Term Care Community Coalition. Available at https://nursinghome411.org/ap-list/.

  • LTCCC’s list of antipsychotic drugs provides an overview of commonly prescribed first- and second-generation antipsychotic medications, outlining their routes of administration, uses, and side effects. While these drugs are sometimes used to manage symptoms like psychosis or agitation in elderly patients with dementia, the page emphasizes that none are FDA-approved for this purpose and highlights the serious risks, including stroke, Parkinsonism, and death, especially in older adults.

Antipsychotic drug use and risk of stroke and myocardial infarction: a systematic review and meta-analysis. (2019). Zivkovic, S., Koh, C. H., Kaza, N., & Jackson, C. A. BMC Psychiatry, 19(1), 189. Available at https://doi.org/10.1186/s12888-019-2177-5.

  • This systematic review found that antipsychotic (AP) drug use may be associated with an increased risk of stroke, particularly in the general population, though the risk appeared lower among people with dementia. The review found no clear association between AP use and myocardial infarction, but heterogeneity and limited data make conclusions uncertain.

Antipsychotic use in dementia: A systematic review of benefits and risks from meta-analyses. (2016). Tampi, R. R., Tampi, D. J., Balachandran, S., & Srinivasan, S. Therapeutic Advances in Chronic Disease, 7(5), 229–245. Available at https://doi.org/10.1177/2040622316658463.

  • This systematic review found that antipsychotics offer modest benefits in managing aggression, agitation, and psychosis in people with dementia, especially Alzheimer’s disease. However, their use is limited by significant risks—including death, stroke, and cognitive decline—highlighting that these medications should only be used for severe symptoms unresponsive to non-drug approaches.

Antipsychotic Use in Older Adults with Dementia: Community and Nursing Facility Trends in Texas, 2015–2020. (2025). Kim, Y., Krause, T. M., Samper-Ternent, R., & Teixeira, A. L. Journal of the American Medical Directors Association. Advance online publication. Available at https://doi.org/10.1016/j.jamda.2024.105463.

  • This study examines trends in antipsychotic medication use among older adults with Alzheimer’s disease and related dementias (ADRD) in Texas from 2015 to 2020, focusing on differences between those living in nursing facilities and those in the community. Importantly, the steady level of use in community settings highlights the need for increased attention to antipsychotic prescribing practices outside facilities, since two-thirds of people with dementia live in the community.

Associations between psychotropic and anti-dementia medication use and falls in community-dwelling older adults with cognitive impairment. (2023). Martinez, P., et al. Archives of Gerontology and Geriatrics, 114, 105105. Available at https://doi.org/10.1016/j.archger.2023.105105.

  • This study examines the association between psychotropic and anti-dementia medication use and falls in older adults with cognitive impairment. It found that psychotropic medications, especially antidepressants, increased the risk of falls, while anti-dementia medications did not reduce fall risk. The study emphasizes the importance of managing depressive symptoms, potentially through non-pharmacological methods, to prevent falls in this population and highlights the need for further research on the risks and benefits of psychotropic medication withdrawal.

Health Outcomes of Discontinuing Antipsychotics After Hospitalization in Older Adults. (2025). Yang, C. T., Wilkins, J. M., DiCesare, E., Pritchard, K. T., Chen, Q., Zhang, Y., Kim, D. H., & Lin, K. J. JAMA Psychiatry. Advance online publication. Available at https://doi.org/10.1001/jamapsychiatry.2025.0702.

  • This cohort study analyzed nationwide Medicare and commercial claims data to assess outcomes of older adults (65+) who started antipsychotics after hospitalization. Discontinuing antipsychotics post-discharge was associated with lower risks of rehospitalization, delirium, falls, urinary tract infections, and death compared to continued use.

Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know. (2009). Lindsey, P. L. Journal of Gerontological Nursing, 35(9), 28–38. Available at https://doi.org/10.3928/00989134-20090731-01.

  • This article highlights the need for geriatric nurses to understand the effects, risks, and appropriate management of commonly prescribed psychotropic drugs, emphasizing education, careful monitoring, and nonpharmacological alternatives. Psychotropic medications are widely used among older adults across various care settings, but their age-related vulnerabilities and risks, such as falls, cognitive decline, and adverse drug reactions, make their use especially concerning.

Treatments for behavior. Alzheimer’s Association. Available at https://www.alz.org/alzheimers-dementia/treatments/treatments-for-behavior.

  • This Alzheimer’s Association webpage explains that behavioral symptoms such as aggression, agitation, and anxiety are common in individuals with Alzheimer’s and can result from environmental triggers, medical issues, or communication difficulties. It emphasizes starting with non-drug interventions to address comfort and emotional needs, with medications used cautiously in severe cases due to potential risks.