Which antipsychotic is listed for dementia with Alzheimer-type psychosis and behavioral symptoms?

• A. Clozapine
• B. Olanzapine
• C. Haloperidol
• D. Risperidone

Answer: (B)

Managing dementia with Alzheimer-type psychosis and behavioral symptoms hinges on using an antipsychotic that effectively reduces hallucinations, delusions, and agitation while minimizing movement-related side effects in an elderly patient. Among the options, olanzapine is favored because it tends to provide meaningful control of psychotic and behavioral symptoms with a lower risk of extrapyramidal symptoms than typical antipsychotics like haloperidol. This is important in older adults, where movement disorders can significantly impair function and quality of life.

All antipsychotics in this population carry a warning about increased mortality, so they should be started at the lowest effective dose and used only when nonpharmacologic approaches have not enough controlled symptoms. Clozapine, while effective for some resistant cases, carries a serious risk of agranulocytosis and requires regular blood monitoring, making it less suitable here. Haloperidol is more likely to cause extrapyramidal symptoms and other adverse effects, which limits its desirability in dementia. Risperidone can be used for behavioral symptoms but is associated with a higher risk of EPS and prolactin elevation, and some regimens note cardiovascular or cerebrovascular risks in elderly patients.