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  • Print publication year: 2009
  • Online publication date: September 2009

17 - Treatment of behavioral symptoms in vascular dementia

from Section 3 - Treatment

Summary

This chapter outlines some characteristics of vascular dementia (VaD) related to large-vessel diseases in terms of pathology, pathogenesis, and clinical aspects. Large-vessel VaD is characterized by a step-wise cognitive deterioration, focal signs and symptoms which are the result of repeated ischemic strokes. The chapter reviews some of large-vessel diseases such as atherosclerosis, arterial dissection, angiitis, moyamoya disease, and intracranial arterial dolichoectasia. The pathogenesis of large-vessel VaD is complex and to some extent remains a matter of investigation. Efforts in defining diagnostic criteria are made in order to characterize patterns of brain infarction from which it is reliable to deduce the presence of dementia. Some of the most important pathophysiological mechanisms and factors implicated in large-vessel VaD are volume of lesions, number of lesions, location of lesions, and coexistence of other brain pathologies, particularly Alzheimer's disease (AD).

References

AlessiCA, YoonEJ, SchnelleJF, Al SamarraiNR, CruisePA. A randomized trial of a combined physical activity and environment intervention in nursing home residents: do sleep and agitation improve?J Am Geriatr Soc 1999; 47: 784–91.
AlexopoulosG, AbramsR, YoungR, ShamoianC. Cornell scale for depression in dementia. Biol Psychiatry 1988; 23: 271–84.
AllenH, ByrneEJ, SutherlandD, TomensonB, ButterB, BurnsA. Bright light therapy, diurnal rhythm and sleep in dementia. Int Psychogeriatrics 2003; 15(S12): 97–8.
BallardC, O’BrienJT. Behavioural and psychological symptoms. In: Erkinjuntti T, Gauthier S, eds. Vascular cognitive impairment, London: Martin Dunitz, 2002; 237–52.
BallardC, McKeithI, O’BrienJ, et al., Neuropathological substrates of dementia and depression in vascular dementia, with a particular focus on cases with small infarct volumes. Dementia Geriatr Cogn Disord 2000; 11(2): 59–65.
BallardC, NeillD, O’BrienJ, McKeithIG, InceP, PerryR. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Dis 2000a; 59(2): 97–106.
BallardC, Margallo-LanaM, JuszczakE, et al. Quetiapine and rivastigmine and cognitive decline in Alzheimer’s disease: a randomised, placebo-controlled trial. Br Med J 2005; 330(7496): 874.
BallardCG, PatelA, SolisM, LoweK, WilcockG. A one-year follow-up study of depression in dementia sufferers. Br J Psychiatry 1996; 168: 287–91.
BallardC, O’BrienJ, JamesI, SwannA. Dementia: management of behavioral and psychological symptoms. Oxford: Oxford University Press, 2001.
BNF, 2006.
BMJ Publishing Group, RPS Publishing, March 2006. British National Formulary
BrodatyH, AmesD, SnowdonJ, et al. A randomized controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry 2003; 64: 134–43.
BurnsA, RussellE, Stratton-PowellH, TyrrellP, O’Neill P, BaldwinR. Sertraline in stroke-associated lability of mood. Int J Geriat Psychiatry 1999; 14: 681–5.
ByrneJ, BallardC, HolmesC. Sensory stimulation in dementia. An effective option for managing behavioral problems. Br Med J 2002; 325: 1312–13.
CantillonM, BrunswickR, MolinaD, et al., Buspirone vs haloperidol: a double-blind trial for agitation in a nursing home population with Alzheimer’s disease. Am J Geriatr Psychiatry 1996; 4: 263–7.
ChanW, LamLC, ChoyCN, LeungVP, LiS, ChiuHF.A double-blind randomised comparison of risperidone and haloperidol in the treatment of behavioral and psychological symptoms in Chinese dementia patients. Int J Geriatr Psychiatry 2001; 16: 1156–62.
ChiuE.Vascular burden and BPSD: a reconceptualization. Int Psychogeriatrics 2003; 15(1): 183–6.
ChiuE, YastrubetskayaO, WilliamsM. Pharmacotherapy of mood and behavior symptoms. In: ErkinjunttiT, GauthierS, eds. Vascular cognitive impairment. London: Martin Dunitz, 2002.
CoccaroEF, KramerE, ZemishlanyZ, et al., Pharmacological treatment of non-cognitive behavioral disturbances in elderly demented patients. Am J Psychiatry 1990; 147: 1640–5.
CohenD, EisdorferC, GorelickP, et al. Psychopathology associated with Alzheimer’s disease and related disorders. J Gerontology 1993; 8(6): M255–60.
Cohen-MansfieldJ, BilligN. Agitated behaviors in the elderly, I: a conceptual review. J Am Geriatr Soc 1986; 34: 711–21.
Cohen-MansfieldJ, WernerP, MarxMS. An observational study of agitation in nursing home residents. Int Psychogeriatr 1989; 1: 153–65.
Cohen-MansfieldJ, Nonpharmacologic interventions for psychotic symptoms in dementia. Psychiatry Neurol 2003; 16: 219–24.
CooperJK, MungasD. Risk factor and behavioral differences between vascular and Alzheimer’s dementias: the pathway to end-stage disease. J Geriatr Psychiatry Neurol 1993; 1: 29–33.
CummingsJL. A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am J Psychiatry 1993; 150: 1806–12.
CummingsJL, MegaM, GrayK, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308–14.
CummingsJL. Vascular subcortical dementias: clinical aspects. Dementia 1994; 5: 177–80.
CummingsJL. Cholinesterase inhibitors: a new class of psychiatric compound. Am J Psychiatry 2000; 157: 4–15.
DeDeynPP, RabheruK, RasmussenA, et al. A randomised trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999; 53: 946–55.
DevanandDP. Conventional neuroleptics in dementia. Int Psychogeriatr 2000; 12 (suppl 1): 253–61.
DonaldsonC, TarrierN, BurnsA. The impact of the symptoms of dementia on caregivers. Br J Psychiatry 1997; 170: 62–8.
DouglasS, JamesI, BallardC. Non-pharmacological interventions in dementia. Adv Psychiatric Treat 2004; 10: 171–9.
ErkinjunttiT, GauthierS. Vascular cognitive impairment. London: Martin Dunitz, 2002.
ErkinjunttiT, VatajaR, LeppavuoriA. Behavioural and psychological symptoms of dementia and vascular dementia. Int Psychogeriatr 2000; 12 (Suppl 1): 195–200.
FinkelS. Introduction to behavioral and psychological symptoms of dementia (BPSD). Int J Geriatr Psychiatry 2000; 15: S2–4.
FinkelS, SilvaCE, CohenG, MillerS, SartoriusN. Behavioural and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int J Geriatr Psychiatry 1997; 12: 1060–1.
FujikawaT, TakahashiT, KinoshitaA, et al. Quetiapine treatment for behavioral and psychological symptoms in patients with senile dementia of Alzheimer type. Neuropsychobiology 2004; 49: 201–04.
GrovesWC, BrandtJ, SteinbergM, et al. Vascular dementia and Alzheimer’s disease: is there a difference? A comparison of symptoms by disease duration. J Neuropsychiatry Clin Neurosci 2000; 12: 305–15.
HawkinsJW, TinklenbergJR, SheikhJI, et al. A retrospective chart review of gabapentin for the treatment of aggressive and agitated behavior in patients with dementias. Am J Geriar Psychiatry 2000; 8: 221–5.
HerrmannN. Valproic acid in the treatment of agitation in dementia. Can J Psychiatry 1998; 43: 69–72.
HerrmannN. Recommendations for the management of behavioral and psychological symptoms of dementia. Can J Neurol Sci 2001, 28: (Suppl 1): S96–107.
HolmbergSK. Evaluation of a clinical intervention for wanderers on a geriatric nursing unit. Arch Psychiatric Nurs 1997; 11: 21–8.
HopeT, KeeneJ, FairburnC, McShaneR, JacobyR. Behaviour changes in dementia 2: are there behavioral syndromes?Int J Geriatr Psychiatry 1997; 12: 1074–8.
HowardR, BallardC, O’BrienJ, BurnsA. Guidelines for the management of agitation in dementia. Int J Geriatr Psychiatry 2001; 16: 714–17.
JesteDV, CaliguiriMP, PaulsenJS, et al. Risk of tardive dyskinesia in older patients. A prospective longitudinal study of 266 outpatients. Arch Gen Psychiatry 1995; 52: 756–65.
KatzIR, JesteDV, MintzerJE, et al. 1999. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial (Risperidone study group). J Clin Psychiatry 1999; 60: 107–15.
KingAC, OmanRF, BrassingtonGS, BliwiseDL, HaskellWL. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomised controlled trial. JAMA 1997; 277: 32–7.
KozmanMN, WattisJ, CurranS. Pharmacological management of behavioral and psychological disturbance in dementia. Hum Psychopharmacol Clin Exp 2006; 21: 1–12.
KunikME, HuffmanJC, BharaniMD, HillmanSL, MolinariVA, OrengoCA. Behavioural disturbance in geropsychiatric inpatients across dementia types. J Geriatr Psychiatry Neurol 2000; 13: 49–52.
LawlorB. Managing behavioral and psychological symptoms in dementia. Br J Psychiatry 2002; 181: 463–5.
LawlorB, RadcliffeJ, MolchenSE, et al. A pilot placebo-controlled study of trazodone and buspirone in Alzheimer’s dementia. Int J Geriatr Psychiatry 1994; 9: 55–9.
LavretskyH, ChuiHC. Vascular dementia. In: AgroninME, MalettaGJ, eds. Principles and practice of geriatric psychiatry. Balhimore MD: Lippincott Williams and Wilkins, 2006; 301–10.
LeroiI, VoulgariA, BreitnerJCS, LyketsosCG. The epidemiology of psychosis in dementia. Am J Geriatr Psychiatry 2003; 11: 83–91.
LiY-S, MeyerJS, ThornbyJ. Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly. Int J Geriatr Psychiatry 2001; 16: 818–727.
LindK, EdmanA, KarlssonI, SjogrenM, WallinA. Relationship between depressive symptomatology and the subcortical brain syndrome in dementia. Int J Geriatr Psychiatry 2002; 17(8): 774–8.
LivingstonG, JohnstonK, KatonaC, PatonJ, LyketsosCG, Old Age Task Force of the World Federation of Biological Psychiatry. Systematic review of psychological treatment approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005; 162: 1996–2021.
LonerganE, LuxenbergJ, ColfordJ, BirksJ. Haloperidol for agitation in dementia. Cochrane Database of Systematic Reviews, 2002. Issue 2. Art No.: CD002852. DOI: 10.1002/14651858.CD002852.
LyketsosCG, Lindell VeielL, BakerA, SteeleC. A randomized controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care. Int J Geriatr Psychiatry 1999; 14(7): 520–5.
LyketsosCG, SteinbergM, TschanzJT, NortonMC, SteffensDC, BreitnerJCS. Mental and behavioral disturbances in dementia: findings from the cache county study on memory in aging. Am J Psychiatry 2000; 157: 708–14.
McKeithI. Galantamine for vascular dementia. Lancet Neurol 2002; 1: 210.
McKeithI. Dementia with Lewy bodies. In: AgroninME, MalettaGJ eds. Principles and practice of geriatric psychiatry. Baltimore, MD: Lippincott Williams and Wilkins, 2006; 311–18.
McManusDQ, ArvanitisLA, KowalcykBB. Quetiapine, a novel antipsychotic: experience in elderly patients with psychotic disorders. Seroquel trial 48 study group. J Clin Psychiatry 1999; 60: 292–8.
McShaneR, KeeneJ, GedlingK, et al. Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up. Br Med J 1997; 314: 266–70.
MayerR, DarbySJ. Does a mirror deter wandering in demented older people?Int J Geriatr Psychiatry 1991; 6: 607–09.
MillerLJ. Gabapentin for treatment of behavioral and psychological symptoms of dementia. Ann Pharmacother 2001; 35: 427–31.
MorettiR, TorreP, AntonelloRM, CattaruzzaT, CazzatoG. Olanzapine as a possible treatment of behavioral symptoms in vascular dementia: Risks of cerebrovascular events. J Neurol 2005; 252: 1186–93.
MorettiR, TorreP, AntonelloRM, CazzatoG. Behavioural alterations and vascular dementia. The Neurologist 2006; 12(1): 43–7.
NamaziKH, GwinnupPB, ZadoroznyCA. A low intensity exercise/movement program for patients with Alzheimer’s disease: the TEMP-AD protocol. J Aging Phys Activity 1994; 2: 80–92.
National Institute for Health and Clinical Excellence, Social Care Institute for Excellence. Dementia: Supporting people with dementia and their carers in health and social care. NICE clinical guideline 42, November. National Collaborating Centre for Mental Health, 2006.
NewmanSC. The prevalence of depression in Alzheimer’s disease and vascular dementia in a population sample. J Affect Dis 1999; 52: 169–76.
O’BrienJT, ErkinjunttiT, ReisbergB, et al. Vascular cognitive impairment. Lancet Neurol 2003; 2(Feb): 89–98.
O’BrienJ. Behaviours symptoms in vascular cognitive impairment and vascular dementia. Int J Psychogeriatrics 2003; 15(1): 133–8.
O’DonnellBF, DrachmanDA, BarnesHJ, et al. Incontinence and troublesome behaviors predict institutionalisation in dementia. J Geriatr Psychiatry Neurol 1992; 5: 45–52.
OpieJ, RosewarneR, O’ConnorDW. The efficacy of psychosocial approaches to behavior disorders in dementia: a systematic literature review. Aust NZ Psychiatry 1999; 33: 789–99.
OvershottR, BurnsA. Treatment of dementia. J Neurol, Neurosurg Psychiatry 2005; 76 (5): 53–9.
PerrinT. Lifted into a world of rhythm and melody. J Dementia Care 1998; 5: 18–19.
PintoC, SeethalakshmiR. Behavioural and psychological symptoms of dementia in an Indian population: Comparison between Alzheimer’s disease and vascular dementia. Int Psychogeriatrics 2006; 18(1): 87–93.
PorsteinssonAP, TariotPN, ErbR, et al. Placebo-controlled study of divalproex sodium for agitation in dementia. Am J Geriatr Psychiatry 2001; 9: 58–66.
PurandareN, AllenNHP, BurnsA. Behavioural and psychological symptoms of dementia. Rev Clin Gerontol 2000; 10: 245–60.
ReisbergB, BorensteinJ, SalobSP, et al. Behavioural symptoms in Alzheimer’s disease – phenomenology and treatment. J Clin Psychiatry 1987; 48(Suppl 5): 9–15.
RobertP. Understanding and managing behavioral symptoms in Alzheimer’s disease and related dementias: Focus on rivastigmine. Curr Med Res Opin 2002; 18(3): 156–71.
RockwoodK, SheaC. Behavioural and psychological symptoms in vascular cognitive impairment. In: BowlerJV, HachinskiV, eds. Vascular cognitive impairment: preventable dementia. Oxford: Oxford University Press, 2003.
RomanGC. Facts, myths, and controversies in vascular dementia. J Neurol Sci 2004; 226: 49–52.
RomanGC. Rivastigmine for subcortical vascular dementia. Expert Rev Neurotherapeutics 2005; 5(3): 309–13.
RoslerM. The efficacy of cholinesterase inhibitors in treating the behavioral symptoms of dementia. Int J Clin Pract 2002; Supplement 127 June: 20–36.
SandbornWD, BendfeldtF, HamdyR. Valproic acid for physically aggressive behavior in geriatric patients. Am J Geriatr Psychiatry 1995; 3: 239–42.
SchneiderLS, TariotPN, DagermanKSet al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med 2000; 335 (15): 1525–38.
SchneiderLS, DagermanKS, InselP. Risk of death with atypical antipsychotic drug treatment for dementia. JAMA 2005; 294: 1934–43.
SivalRC, HaffmansPMJ, JansenPAF, DuursmaSA, EikelenboomP. Sodium valproate in the treatment of aggressive behavior in patients with dementia: A randomized placebo controlled clinical trial. Int J Geriatr Psychiatry 2002; 17(6): 579–85.
StreetJ, ClarkS, GannonKS. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer’s disease in nursing care facilities: A double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 2000; 57: 968–77.
SultzerDL, LevinHS, MahlerME, HighWM, CummingsJL. A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am J Psychiatry 1993; 150: 1806–12.
SwearerJM, DrachmanDA, O’DonnellBF, MitchellAL. Troublesome and disruptive behaviors in dementia. Relationships to disease severity. J Am Geriatr Soc 1988; 36(9): 784–90.
TariotP, GaileSE, CastelliNA, PorsteinssonAP. Treatment of agitation in dementia. New Direct Mental Hlth Serv 1997; 76: 109–23.
TariotPN. Treatment of agitation in dementia. J Clin Psychiatry 1999; 60 (Suppl 8): 11–20.
TariotPN, ErbR, PodgorskiCA, et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998; 155: 54–61.
TeriL, LogsdonRG, McCurrySM. Nonpharmacologic treatment of behavioral disturbance in dementia. Med Clin N Am 2002; 86: 641–56.
VatajaR, PohjasvaaraT, LeppavuoriA, et al. Magnetic resonance imaging correlates of depression after ischaemic stroke. Arch Gen Psychiatry 2001; 58: 925–31.
WhallAL, BlackME, GrohCJ, YankouDJ, KupferschmidBJ, FosterNL. The effect of natural environments upon agitation and aggression in late-stage dementia patients. Am J Alzheimer’s Dis 1997; 12: 216–20.