Neuroleptic discontinuation during dementia care: A recent trial and its implications for practice

This Practice Point commentary discusses the DART-AD trial, a prospective study investigating neuroleptic discontinuation. Patients with dementia of the Alzheimer type who were in residential care and taking neuroleptics for 3 months or longer, were randomized to receive one of two 12-month interventions: continuation or discontinuation of neuroleptic treatment. The primary aim was to determine whether neuroleptic discontinuation improves cognitive outcomes. After 6 months, neuroleptic discontinuation was not detrimental to cognition or function in patients with Alzheimer's disease, except for those who had Neuropsychiatric Inventory scores ≥15 at enrollment (these patients had even higher Neuropsychiatric Inventory scores at 12 months). This commentary highlights methodological issues pertinent to the translation of these results and also considers implications for everyday practice. From a practice perspective, it would seem that judicious prescribing and timely discontinuation might optimize the risk-benefit balance of neuroleptics.