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Behavioral and Neuropsychiatric Outcomes in Alzheimer's Disease

Published online by Cambridge University Press:  07 November 2014

Jeffrey L. Cummings
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Abstract

Behavioral and psychological symptoms of dementia pose significant challenges in the management of patients with Alzheimer's disease. Neuropsychiatric symptoms are associated with cognitive decline, highly impaired activities of daily living, and frontal lobe pathology. Moreover, behavioral and psychological symptoms can diminish patient quality of life, increase caregiver distress, and accelerate nursing home placement. Although these symptoms are often associated with the later stages of Alzheimer's disease, a high percentage of individuals with mild cognitive impairment or mild Alzheimer's report symptoms as well. This article provides an overview of behavioral and neuropsychiatric symptoms associated with Alzheimer's disease and discusses nonpharmacologic and pharmacologic approaches to the management of such symptoms. For patients with severe behavioral and psychological symptoms of dementia, pychotropic agents may be warranted, whereas approved therapies for Alzheimer's, including cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine, may be appropriate in less severe cases.

Type
Academic Supplement
Information
CNS Spectrums , Volume 10 , Issue S18: Alzheimer's Disease Pathways to Practice: Assessing Diagnosis and Outcome Measures , November 2005 , pp. 22 - 25
Copyright
Copyright © Cambridge University Press 2005

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References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
2.Mega, MS, Cummings, JL, Fiorello, T, Gornbein, J. The spectrum of behavioral changes in Alzheimer's disease. Neurology. 1996;46:130–135.Google Scholar
3.Shin, IS, Carter, M, Masterman, D, Fairbanks, L, Cummings, JL. Neuropsychiatric symptoms and quality of life in Alzheimer disease. Am J Geriatr Psychiatry. 2005;13:469–474.Google Scholar
4.O'Brien, JA, Caro, JJ. Alzheimer's disease and other dementia in nursing homes: levels of management and cost. Int Psychogeriatr. 2001;13:347–358.Google Scholar
5.Wolstenholme, J, Fenn, P, Gray, A, et al.Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry. 2002;181:36–42.Google Scholar
6.Phillips, VL, Diwan, S. The incremental effect of dementia-related problem behaviors on the time to nursing home placement in poor, frail, demented older people. J Am Geriatr Soc. 2003;51:188–193.CrossRefGoogle ScholarPubMed
7.Beck, C. Psychosocial and behavioral interventions for Alzheimer's disease patients and their families. Am J Geriatr Psychiatry. 1998;6(2 suppl 1):S41–S48.Google Scholar
8.Aricept (package insert). New York, NY: Pfizer; 2004.Google Scholar
9.Exelon (package insert). East Hanover, NJ: Novartis Pharmaceuticals; 2004.Google Scholar
10.Namenda (package insert). St. Louis, MO: Forest Laboratories; 2003.Google Scholar
11.Razadyne (package insert). Titusville, NJ: Ortho-McNeil Neurologies; 2005.Google Scholar
12.Alexopoulos, GS, Katz, IR, Reynolds, CF, et al.The Expert Consensus Guideline Series: pharmacotherapy in older patients. Postgrad Med. 2001;110(Oct special report):1–86.Google Scholar
13.Doody, RS, Stevens, JC, Beck, C, et al.Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:1154–1166.Google Scholar
14.Blesa, R. Noncognitive symptoms and long-term treatment expectations for Alzheimer disease. Alzheimer Dis Assoc Disord. 2004;(18 suppl 1):S9–S16.Google Scholar
15.Feldman, H, Gauthier, S, Hecker, J, et al.A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer's disease. Neurology. 2001;57:613–620.CrossRefGoogle ScholarPubMed
16.Gauthier, S, Feldman, H, Hecker, J, et al.Efficacy of donepezil on behavioral symptoms in patients with moderate to severe Alzheimer's disease. Int Psychogeriatr. 2002;14:389–404.Google ScholarPubMed
17.Cummings, JL, van Dyck, C, Schmitt, FA, et al. Functional and behavioral effects of memantine in Alzheimer's disease. Poster presented at: The 56th Annual Meeting of the American Academy of Neurology; April 24-May 1, 2004; San Francisco, CA.Google Scholar
18.Cummings, JL, Schneider, E., Peskind, E, et al. Effect of memantine on behavioral outcomes in Alzheimer's disease. Poster presented at: 57th Annual Meeting of the American Academy of Neurology; April 9-16, 2005; Miami Beach, FL.Google Scholar
19.Singh, S, Wooltorton, E. Increased mortality among elderly patients with dementia using atypical antipsychotics. CMAJ. 2005;173:252.Google Scholar
20.Bullock, R. Treatment of behavioural and psychiatric symptoms in dementia: implications of recent safety warnings. Curr Med Res Opin. 2005;21:1–10.Google Scholar
21.Nasrallah, HA, Mulvihill, T. Iatrogenic disorders associated with conventional vs. atypical antipsychotics. Ann Clin Psychiatry. 2001;13:215–227.Google Scholar
22.Lawlor, BA. Behavioral and psychological symptoms in dementia: the role of atypical antipsychotics. J Clin Psychiatry. 2004;65(suppl 11):5–10.Google Scholar
23.Solai, LK, Mulsant, BH, Pollock, BG. Selective serotonin reuptake inhibitors for late-life depression: a comparative review. Drugs Aging. 2001;18:355–368.CrossRefGoogle ScholarPubMed