Evidence and decision algorithm for the withdrawal of antipsychotic treatment in the elderly with dementia and neuropsychiatric symptoms

Miarons, Marta; Cabib, Christopher; Barón, Francisco Javier; Rofes, Laia

doi:10.1007/s00228-017-2314-3

Cited by 5 publications

(4 citation statements)

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“…Неврология, нейропсихиатрия, психосоматика. 2022;14(3): [54][55][56][57][58][59][60][61] типсихотиков часто ассоциируется с серьезными побочными эффектами и повышенной смертностью у пациентов с деменцией [28]. Причины повышенной смертности при приеме антипсихотиков до сих пор неясны.…”

Section: мг утром 1 раз в день с 4-й недели по 20 мг 1 раз утром пост...unclassified

“…Несмотря на то что длительное лечение антипсихотиками связано с повышенным риском смертности, их использование может оправдываться определенными медицинскими обстоятельствами. Даже если решение о применении антипсихотиков может быть клинически оправданным, в руководствах рекомендовано проведение регулярных попыток отмены этих препаратов [56] и были предложены практические алгоритмы для прекращения употребления антипсихотиков [57]. Достойной альтернативой нейролептикам может быть назначение мемантина, который является базисным препаратом для лечения деменции.…”

Section: мг утром 1 раз в день с 4-й недели по 20 мг 1 раз утром пост...unclassified

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Neuropsychiatric disorders correction in Alzheimer's disease

Koberskaya

2022

RJTAO

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Behavioral and neuropsychiatric symptoms occur in 80% of patients with Alzheimer's disease (AD) and represent one of the most common reasons for early hospitalization and increased treatment costs. It is believed that the development of mental disorders (MD) is a marker of a number of additional adverse outcomes in patients with AD. The disease is accompanied by the development of other behavioral disorders, the most unpleasant of which are agitation (excitation) and aggression. The article discusses the causes and factors that can provoke the development of MD in AD. Traditionally used pharmacotherapeutic methods for the treatment of MD in AD in this age group have limited efficacy and are characterized by high toxicity. Antipsychotics are often associated with serious side effects and increased mortality in patients with dementia. A clinical case of AD with the development of neuropsychiatric disorders is presented. We discuss the issue of nonpharmacological strategies that have been shown to be more effective than pharmacological treatment and have fewer side effects than antipsychotic pharmacotherapy. On the example of the given clinical case, modern approaches to the correction of such complications and the management of this group of patients are shown. It seems appropriate to use memantine (akatinol memantine) in patients with neuropsychiatric symptoms of AD. In clinical studies, memantine has shown a positive effect in terms of reducing the rate of deterioration of general, cognitive, functional and behavioral parameters compared with treatment with antipsychotics. The drug is characterized by a minimum number of side effects and a limited range of contraindications.

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Section: мг утром 1 раз в день с 4-й недели по 20 мг 1 раз утром пост...unclassified

Neuropsychiatric disorders correction in Alzheimer's disease

Koberskaya

2022

RJTAO

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“…However, while long-term antipsychotic treatment is known to be associated with an increased risk of mortality, their use may be justified by circumstances. Even if the decision to implement the treatment may be clinically justified, regular attempts to withdraw these drugs are recommended in guidelines ( Azermai et al., 2012 ), and practical algorithms have been proposed for process of drug discontinuation ( Miarons et al., 2017 ). Even so, withdrawal of these drugs has consequences, especially after long-term use, including the obvious risk of re-aggravation of NPSs.…”

Section: Review Of Current Knowledge On Bpsd Managementmentioning

confidence: 99%

Pharmacotherapy of Behavioral and Psychological Symptoms of Dementia: State of the Art and Future Progress

et al. 2020

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The core symptoms of different dementia subtypes are the behavioral and psychological symptoms of dementia (BPSD) and its neuropsychiatric symptoms (NPS). BPSD symptoms may occur at any stage in the case of dementia due to Alzheimer’s disease (AD), whereas they tend to occur early on in the case of its behavioral variant frontotemporal dementia or dementia with Lewy bodies and are essential for diagnosis. BPSD treatment consists of non-pharmacological as well as pharmacological interventions, with non-pharmacological interactions being suggested as first-line treatment. Agitation, psychotic features, apathy, depression, and anxiety may not respond to acetylcholinesterase inhibitors or memantine in AD cases; therefore, antipsychotics, antidepressants, sedative drugs or anxiolytics, and antiepileptic drugs are typically prescribed. However, such management of BPSD can be complicated by hypersensitivity to antipsychotic drugs, as observed in DLB, and a lack of effective pro-cognitive treatment in the case of frontotemporal dementia. The present paper reviews current knowledge of the management of BPSD and its limitations and discusses on-going clinical trials and future therapeutic options.

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“…Antipsychotic agents are commonly used for the management of behavioral or psychotic problems due to dementia but not usually recommended due to their stumpy brain penetration and less therapeutic potential. Hence further studies are required to explore the hidden targets to achieve better drug therapy to secure life [14].…”

Section: Introductionmentioning

confidence: 99%

Alzheimer’s Disease Silent Killer of Memory: A Review on Pathological Mechanisms

Singh¹

2019

AND

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Alzheimer's Disease (AD) is a Central Nervous System (CNS) related neurological disorder characterized by impairment of memory and finally turbulence in learning, reasoning, planning, language and perception. AD is a complex disease caused by an accretion of β -Amyloid (Aβ) plaques and neurofibrillary tangles formed by Tau amyloid fibrils linked with loss of synaptic plasticity and neurodegeneration. Apart from several other environmental factors, the rise in Oxidative Stress (OS), failure of mitochondria and Golgi plays a crucial role in neuronal dysfunctioning leads to neurodegeneration. However, oxygen is necessary for life and any imbalance between metabolism and excess Reactive Oxygen Species (ROS) generation leads to the origin of disorders such as Alzheimer's disease. The ROS induced Mitochondrial (Mt) dysfunctions and excitotoxicity through over Ca 2+ influx are two hallmarks behind neurodegeneration in AD. Still, there is no medicament presently available which can prevent further progression or decrease the symptoms of this disease. Some anti-oxidants were used but they were not effective due to their bioavailability problem into brain. The absence of effec-tive therapeutic drugs and increased severity of AD day by day is a big challenge for against researchers. Therefore this review basically focused to explore the underlying pathological mechanism behind neuronal dysfunctioning and the various pathways involved in the pathogenesis of AD.

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Evidence and decision algorithm for the withdrawal of antipsychotic treatment in the elderly with dementia and neuropsychiatric symptoms

Abstract: In this paper, we review the potential risks and benefits of discontinuing AP treatment in elderly demented patients with NPS and propose an algorithm to assist in decision-making regarding AP withdrawal.

Cited by 5 publications

References 76 publications

Neuropsychiatric disorders correction in Alzheimer's disease

Neuropsychiatric disorders correction in Alzheimer's disease

Pharmacotherapy of Behavioral and Psychological Symptoms of Dementia: State of the Art and Future Progress

Alzheimer’s Disease Silent Killer of Memory: A Review on Pathological Mechanisms

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