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Pimavanserin provides short-term benefit in Alzheimer’s disease psychosis

A study suggests that pimavanserin may be safer than traditional antipsychotic medications for people with Alzheimer’s disease

A study suggests that pimavanserin may be safer than traditional antipsychotic medications for people with Alzheimer’s disease


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About 45 million people worldwide have Alzheimer’s disease and 25% to 50% of them will develop psychotic symptoms at some stage during their illness. Delusions and visual hallucinations are the most common psychotic symptoms.

There may be periods of remission, but coping with psychotic symptoms has a significant effect on people with Alzheimer’s disease and their caregivers. Psychosis is associated with more rapid cognitive and functional decline and with greater burdens on caregivers and depression, as well as earlier institutionalisation and greater treatment-related mortality.

Antipsychotic medications are commonly used but none is approved for treating psychosis in Alzheimer’s disease. Their use is associated with side effects that include accelerated decline in cognition; increased serious medical adverse events such as stroke, bronchopneumonia and pulmonary embolism; and increased short-term mortality. This highlights the need to find a safe and effective pharmacological treatment.

Pimavanserin is an atypical antipsychotic that does not block dopamine receptors. It has been approved in the US for psychosis in people with Parkinson’s disease but not Alzheimer’s disease.

This study aimed to examine the effects of pimavanserin versus a placebo on psychotic symptoms in people with Alzheimer’s disease. The randomised, double-blind, placebo-controlled trial included 90 nursing home residents treated with pimavanserin and 91 in the placebo group.

Results and implications for practice

Evaluation after six weeks showed that the pimavanserin group had a significant reduction in psychosis with no negative effect on cognition or motor function. Further study is needed into longer-term benefits, but these findings suggest that pimavanserin may be safer than traditional antipsychotic medications for people with Alzheimer’s disease.


Ballard C, Banister C, Khan Z et al (2018) Evaluation of the safety, tolerability, and efficacy of pimavanserin versus placebo in patients with Alzheimer’s disease psychosis: a phase 2, randomised, placebo-controlled, double-blind study. The Lancet. Neurology. 17, 3, 213-222.

About the author

Ruth Sander is an independent consultant in the care of older people

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