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To the Editor: In their Clinical Review, Dr Sink and colleagues¹ accurately capture the dilemma faced by clinicians caring for individuals with dementia: although neuropsychiatric symptoms are almost universal and adversely affect both patients and caregivers, evidence-based guidance toward effective pharmacological treatment is sparse. Inadequacy of present systems of symptom classification may account in part for the finding of limited usefulness for pharmacotherapy.

Agitation, delusions, and many other neuropsychiatric symptoms in dementia often present in ways that defy categorization by standard methods (eg, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]). Most treatment studies to date have defined these symptoms as isolated disturbances, such as aggression or anxiety, or as a score above a cutoff on instruments assessing multiple domains. However, neuropsychiatric symptoms frequently occur as specific clusters or syndromes²; 1 study using latent class analysis³ found that neuropsychiatric symptoms in Alzheimer disease clustered . . . [Full Text of this Article]

Martin Steinberg, MD
martins@jhmi.edu

Constantine Lyketsos, MD, MHS
Department of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine
Baltimore, Md

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