Behavioural and Psychological Problems in Dementia (original) (raw)
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Pharmacological management of behavioural and psychological disturbance in dementia
Human Psychopharmacology: Clinical and Experimental, 2006
Behavioural and psychological symptoms in patients with dementia are common, distressing and often difficult to manage. This review evaluates a range of drugs commonly used to manage these symptoms including antipsychotics, anticonvulsants, antidementia drugs and antidepressants.
management of the behavioural and psychological symptoms of dementia
More than 50% of people with dementia experience behavioral and psychological symptoms of dementia (BPSD). BPSD are distressing for patients and their caregivers, and are often the reason for placement into residential care. The development of BPSD is associated with a more rapid rate of cognitive decline, greater impairment in activities of daily living, and diminished quality of life (QOL). Evaluation of BPSD includes a thorough diagnostic investigation, consideration of the etiology of the dementia, and the exclusion of other causes, such as drug-induced delirium, pain, or infection. Care of patients with BPSD involves psychosocial treatments for both the patient and family. BPSD may respond to those environmental and psychosocial interventions, however, drug therapy is often required for more severe presentations. There are multiple classes of drugs used for BPSD, including antipsychotics, anticonvulsants, antidepressants, anxiolytics, cholinesterase inhibitors and NMDA modulators, but the evidence base for pharmacological management is poor, there is no clear standard of care, and treatment is often based on local pharmacotherapy customs. Clinicians should discuss the potential risks and benefi ts of treatment with patients and their surrogate decision makers, and must ensure a balance between side effects and tolerability compared with clinical benefi t and QOL.
Neuropsychiatric symptoms are frequent in people with dementia, result in distress for the people experiencing them and their caregivers, and are a common precipitant of institutional care. The safe and effective treatment of these symptoms is a key clinical priority, but is a long way from being achieved. Psychological interventions are recommended as the first line treatment strategy in most good practice guidelines, and there is emerging evidence of efficacy for agitation and depression. Neuroleptics remain the mainstay of pharmacological treatment, although meta-analyses indicate that they are mainly of benefit for the short-term (up to 12 weeks) treatment of aggression in people with Alzheimer's disease, and there have been increasing concerns about serious adverse effects including mortality. The evidence is limited for other pharmacological approaches for the treatment of agitation, and psychosis in people with Alzheimer's disease is limited, but post-hoc analyses do indicate that memantine may be a promising therapy and aromatherapy may be a useful alternative. Autopsy studies indicate that the adrenergic system may be an important therapeutic target. Clinical experience suggests that antidepressants are effective in people with severe depression in the context of dementia, but the evidence base regarding the broader value of antidepressants is far from clear. There are very few trials specifically focusing upon the treatment of neuropsychiatric symptoms in common non-Alzheimer dementias, which is a major limitation and urgently needs to be addressed to provide an evidence base to enable the safe and effective treatment of these individuals.
Neuropsychiatric symptoms in dementia: Importance and treatment considerations
International Review of Psychiatry, 2008
Neuropsychiatric symptoms are frequent in people with dementia, result in distress for the people experiencing them and their caregivers, and are a common precipitant of institutional care. The safe and effective treatment of these symptoms is a key clinical priority, but is a long way from being achieved. Psychological interventions are recommended as the first line treatment strategy in most good practice guidelines, and there is emerging evidence of efficacy for agitation and depression. Neuroleptics remain the mainstay of pharmacological treatment, although meta-analyses indicate that they are mainly of benefit for the short-term (up to 12 weeks) treatment of aggression in people with Alzheimer's disease, and there have been increasing concerns about serious adverse effects including mortality. The evidence is limited for other pharmacological approaches for the treatment of agitation, and psychosis in people with Alzheimer's disease is limited, but post-hoc analyses do indicate that memantine may be a promising therapy and aromatherapy may be a useful alternative. Autopsy studies indicate that the adrenergic system may be an important therapeutic target. Clinical experience suggests that antidepressants are effective in people with severe depression in the context of dementia, but the evidence base regarding the broader value of antidepressants is far from clear. There are very few trials specifically focusing upon the treatment of neuropsychiatric symptoms in common non-Alzheimer dementias, which is a major limitation and urgently needs to be addressed to provide an evidence base to enable the safe and effective treatment of these individuals.
Management of Neuropsychiatric Symptoms in People with Dementia
CNS Drugs, 2010
Background. Alzheimer's disease (AD) is by far the most common type of dementia and it is commonly considered as a memory disorder although behavioral and psychological (including psychiatric) symptoms (BPSD) are largely represented in these patients. Psychosis could explain the worsening of the functional prognosis in these patients, therefore antipsychotic drugs are comonly prescribed. The risks associated with antipsychotics use limit their recommendation and antidepresants or NDMA (N-methyl-d-aspartate) antagonists could represent an alternative. Aims. The aim of this study was to evaluate changes in the clinical status of the psychomotor agitated patients with neurocognitive disorder on stable antidementia therapy after the addition of antidepressants or NMDA antagonists. Methods. The primary variables of this study are related to the severity of agitation under the action of pharmacological factors. Agitation as part of the BPSD was evaluated by CMAI (Cohen-Mansfield Agitation Inventory)-short version. A total of 37 subjects (24 female, 14 male) participated in this observational study. They received as add-on antidepressants between weeks 1-8 or NMDA antagonists between weeks 8-16. Inclusion criteria were DSM IV-TR criteria for diagnosing dementia, AD and vascular dementia (VD) and also NINDS-ADRDA clinical criteria. Data analysis was achieved through SPSS software, version 20, using ANOVA-paired t-tests and independent t tests. Results. The efficacy of memantine over general agitation was significantly superior to antidepressants. Regarding the modulation of the CMAI scores evolution by the type of neurocognitive disorder, treatment and duration, it was observed that the statistical difference between groups became significant after 8-16 weeks of memantine treatment. At the endpoint visit the decrease in agitation was superior in the AD versus VD group (p = 0.012). Conclusions. The overall trend was toward a decrease of the agitation severity after each treatment trial for both types of dementia, including cumulative drugs effects. In the literature, the data are controversial in terms of prescribing antidepressants in the neurocognitive disorders even when BPSD is important, the keystone being the general consensus of limiting the use of antipsychotics and polypharmacy.
Treatment of agitation in dementia
New directions for mental health services, 1997
Agitation occurs commonly in patients with dementia. Before symptomatic pharmacotherapy is undertaken, it is imperative to perform a sequence of evaluations and interventions to establish whether simpler and safer, nonpharmacologic approaches will be beneficial. When psychotropic medications are used they should be used judiciously, in the lowest effective doses and for the shortest period of time necessary. Ineffective medications should be stopped, and even effective medications should be empirically tapered in most patients to learn whether treatment is still necessary. Antipsychotics probably show the greatest benefit for agitation associated with psychotic features; they have less demonstrated efficacy for agitation not associated with psychotic features. The side effects of typical agents are legion; data are pending regarding atypical agents. The available evidence regarding nonneuroleptic medications ranges from case reports to well-designed, double-blind, placebo-controlled...
The treatment of behavioral disturbances and psychosis associated with dementia
Psychiatria Polska, 2016
Behavioral disturbances and psychosis associated with dementia are becoming an increasingly common cause of morbidity in patients with dementia. Approximately 70% of individuals with dementia will experience agitation, and 75% will experience symptoms of psychosis such as delusions or hallucinations. The goal of this article is to review the pharmacologic treatment options for behavioral disturbances and psychosis associated with dementia. A literature review was conducted on PubMed/Medline using key words of “dementia” and “interventions.” The results were filtered for meta-analysis, clinical trials, and systematic reviews. The results were then reviewed. At this time, the most evidence exists for the use of a second generation antipsychotics (SGAs), but consideration should be given to their collective boxed warning of morbidity/mortality. The evidence for second line treatments are limited. There is limited evidence to support the use of first generation antipsychotics (FGAs), an...
Assessment and management of behavioral and psychological symptoms of dementia
BMJ (Clinical research ed.), 2015
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approache...
Managing agitation in Alzheimer's disease and related disorders
Background: Alzheimer disease (AD) will affect increasing numbers of subjects as the population ages. Patients with AD and related disorders often develop agitation during the moderate to severe stages of their dementia. Agitation is often the reason that dementia patients need to be institutionalized. This review will address the natural history of agitation in AD, dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). It will also discuss the use of antidepressants, antipsychotic agents and anticonvulsant drugs in preventing and treating agitation in dementia patients.