The behavioral and psychological symptoms of dementia present a major challenge in the management of these patients. There is no Food and Drug Administration-indicated medication for the management of these symptoms. Even though atypical antipsychotics are considered safer than conventional antipsychotics, safety concerns have emerged.

The FDA has issued warnings regarding the cardiac and metabolic side effects, cerebrovascular events, and, most recently, mortality risk. This study was conducted in 2003 when physicians were notified of the cerebrovascular risks of risperidone. Since then, similar warnings have been issued for olanzapine and aripiprazole.

The medical records of 58 elderly dementia patients who were taking risperidone and were abruptly switched to olanzapine were reviewed. Clinical Global Impressions scale at assigned retrospectively at switch, and weeks 4–6 assessed treatment.

Baseline and follow-up Clinical Global Impressions scale scores were essentially unchanged. Adverse events were mild to moderate in severity. Mean risperidone dose at switch was 1.54 mg/day (range: 0.25–6 mg/day). Mean olanzapine dose after the switch was 5.69 mg/day (range: 2.52–27.5 mg/day).

Most of the 58 patients were switched from risperidone to olanzapine without any deterioration in their clinical status. Even though it is generally not recommended in elderly patients, abrupt switching did not have any negative consequences in this group of patients.