The objective of this study is to review the role of oral atypical antipsychotic drugs in the management of the behavioural and psychological symptoms of dementia (BPSD). Data source include MEDLINE, Embase, and the Cochrane Library. Reference lists were reviewed and experts were contacted to identify additional trials. The study selection was double blind randomised controlled trials that evaluated the four oral atypical antipsychotic therapies for BPSD. Two reviewers assessed trial validity independently. The data extracted were demographics of patients, study duration, dose of antipsychotic, primary end points, and adverse events.

Seventy-seven abstracts were reviewed. Five randomised trials (1570 patients) evaluating risperidone and olanzapine were identified. The quality of trials was generally good. Most participants were in an institution (>96%), elderly (weighted mean 82.3 years), and had Alzheimer's disease (76.3%). Trials lasted 6-12 weeks. Treatment with atypical antipsychotic drugs was superior to placebo for the primary end point in three of the five trials. Two trials comparing risperidone with haloperidol did not find any differences in the primary measures of efficacy. Adverse events were common and included extrapyramidal symptoms, somnolence, and abnormal gait.