An 82-year-old woman with moderate Alzheimer's dementia develops agitation, physical aggression, and sleep disturbance. After non-pharmacological measures fail, which antipsychotic has the MOST evidence for behavioral and psychological symptoms of dementia (BPSD), despite the class-wide black box warning?
- A Clozapine
- B Haloperidol
- C Risperidone ✓
- D Amisulpride
Correct answer: C. Risperidone
Explanation
Risperidone has the most robust evidence base for BPSD and is the only atypical antipsychotic with regulatory approval for BPSD in some countries. All antipsychotics carry an FDA/EMA black box warning for increased mortality (cerebrovascular events) in elderly with dementia, so use is reserved for severe symptoms after non-pharmacological failure. Haloperidol (typical) has more EPS risk in this population. Clozapine requires hematological monitoring and is impractical. Amisulpride has limited evidence in this context.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.