Recent advances in the management of neuropsychiatric symptoms in dementia

Forlenza, Orestes Vicente; Loureiro, Júlia Cunha; Pais, Marcos Vasconcelos; Stella, Florindo

doi:10.1097/yco.0000000000000309

Cited by 24 publications

(15 citation statements)

References 43 publications

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“…A treatment for dementia NPSs endowed with efficacy and safety still remains a serious challenge. An extrapolation of the effects of antipsychotics in the treatment of primary neuropsychiatric disturbances led to their off label use also in BPSDs, regardless of the differences likely occurring between primary and secondary disorders in terms of neuropsychopathology and, consequently, of effectiveness and safety of the drug [49]. Based on the most expressed NPS in the individual syndrome, other pharmacological agents include antidepressants, methylphenidate, benzodiazepines, zolpidem, Z-agents etc [49].…”

Section: Novel Pharmacological Mechanisms For Npss Of Dementia CLImentioning

confidence: 99%

Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

Scuteri

Rombolà

Morrone

et al. 2019

IJMS

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Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.

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Section: Novel Pharmacological Mechanisms For Npss Of Dementia CLImentioning

confidence: 99%

Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

Scuteri

Rombolà

Morrone

et al. 2019

IJMS

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“…Current evidence indicates that both non-pharmacological and pharmacological treatments show modest efficacy for the management of BPSD [ 5 ]. Most treatment protocols recommend the use of non-pharmacological treatments in combination with pharmacotherapy particularly for the management of those BPSD that are non-responsive to non-pharmacological interventions [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Analgesics in the management of behavioral and psychological symptoms of dementia: a perspective review

Tampi

Hassell

Joshi

et al. 2017

DIC

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The objective of this review was to assess the efficacy and tolerability of analgesics in reducing behavioral and psychological symptoms of dementia (BPSD) among older adults from published randomized controlled trials (RCTs). A literature search was conducted of PubMed, MEDLINE, SCOPUS, PsycINFO, and Cochrane collaboration databases for RCTs in the English language that evaluated the use of analgesics in reducing the severity of BPSD among older adults. Additionally, references of full-text articles that were included in this review were searched for extra studies. We identified a total of three unique RCTs that evaluated the use of analgesics among individuals with BPSD. One of the identified RCTs resulted in a total of three additional published papers in the literature, resulting in a total of six papers to be included in this review. All three RCTs identified some benefit for the use of analgesics in reducing BPSD. The analgesics appeared to be well tolerated in the included studies. Major study limitations include the use of data exclusively from published RCTs and limiting the search to English language publications. Additionally, we did not utilize statistical methods to evaluate the treatment outcomes including tolerability. In conclusion, available evidence although limited indicates that analgesics may reduce BPSD among some individuals with dementia living in nursing homes and are well tolerated.

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“…Neuropsychiatric symptoms (NPS) are a key clinical feature of AD and may appear in all stages. 61,75 In the preclinical stage, these symptoms may represent an increased risk of progression to dementia. 76 During the MCI stage, the syndrome of NPS is called mild behavioral impairment (MBI).…”

Section: Symptomatic Treatmentmentioning

confidence: 99%

“…77 Psychotropic drugs for the treatment of behavioral and psychological symptoms of dementia (BPSD) are generally prescribed, following guidelines and clinical experience in the treatment of primary psychiatric disorders. 75 Treating BPSD is a very complex task, as there is insufficient evidence on the neurobiological mechanisms of many of the behavioral syndromes seen in clinical practice. Therapeutic alternatives are restricted; however, a combination of non-pharmacological interventions and safe pharmacological options remains the best therapeutic approach.…”

Section: Symptomatic Treatmentmentioning

confidence: 99%

Early diagnosis and treatment of Alzheimer’s disease: new definitions and challenges

Pais

Martinez

Ribeiro

et al. 2020

Braz. J. Psychiatry

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The prevalence of Alzheimer's disease (AD), a progressive neurodegenerative disorder, is expected to more than double by 2050. Studies on the pathophysiology of AD have been changing our understanding of this disorder and setting a new scenario for drug development and other therapies. Concepts like the ''amyloid cascade'' and the ''continuum of AD,'' discussed in this article, are now well established. From updated classifications and recommendations to advances in biomarkers of AD, we aim to critically assess the literature on AD, addressing new definitions and challenges that emerged from recent studies on the subject. Updates on the status of major clinical trials are also given, and future perspectives are discussed.

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Recent advances in the management of neuropsychiatric symptoms in dementia

Abstract: Effective and well tolerated treatment of neuropsychiatric syndromes in dementia remains a critically unsolved challenge. We understand that this is an extremely important area of research, and critically required to guide clinical decisions in geriatric neuropsychiatry.

Cited by 24 publications

References 43 publications

Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

Analgesics in the management of behavioral and psychological symptoms of dementia: a perspective review

Early diagnosis and treatment of Alzheimer’s disease: new definitions and challenges

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