Antipsychotics for the Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)

Centro di Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo A. Gemelli, I-00168 Rome, Italy.
Current Neuropharmacology (Impact Factor: 3.05). 07/2008; 6(2):117-24. DOI: 10.2174/157015908784533860
Source: PubMed


Behavioral and psychological symptoms of dementia (BPSD), i.e. verbal and physical aggression, agitation, psychotic symptoms (hallucinations and delusions), sleep disturbances, oppositional behavior, and wandering, are a common and potentially severe problem complicating dementia. Their prevalence is very high and it is estimated that up to 90% of patients with Alzheimer's disease (AD) may present at least one BPSD. Beside the obvious impact on the quality of life of people with dementia, BPSD are responsible for increased risk of patient institutionalization and increased costs. Furthermore, they are associated with caregivers' stress and depression. Drugs used include antipsychotics, antidepressants, anticonvulsivants, anxiolytics, cholinesterase inhibitors and N-methyl-D-aspartate receptor modulators. Among these, the most commonly used are anti-psychotics. These drugs have been used for many decades, but in the last years new compounds have been marketed with the promise of comparable efficacy but less frequent adverse effects (especially extra-pyramidal side effects). Their safety, however, has been challenged by data showing a potential increase in adverse cerebrovascular side effects and mortality. This review will summarize the pathophysiology and neuropharmacology of BPSD, it will describe the characteristics of the anti-psychotics most commonly used focusing on their efficacy and safety in BPSD.

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Available from: Andrea Corsonello, Sep 29, 2015
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    • "Behavioral and Psychological Symptoms of Dementia (BPSD) is the term applied to the various problems that complicate dementia and prevalence is high. It is estimated that up to 90% of patients with Alzheimer’s disease may present at least one BPSD during the course of the disease [2]. BPSD include behaviors such as aggression, screaming, restlessness, and also symptoms such as anxiety, hallucinations and depressive mood [3]. "
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    ABSTRACT: Antipsychotic drugs are widely used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), despite their limited efficacy and concerns about safety. The aim of this study was to describe antipsychotic drug therapy among people with dementia living in specialized care units in northern Sweden. This study was conducted in 40 specialized care units in northern Sweden, with a total study population of 344 people with dementia. The study population was described in regard to antipsychotic drug use, ADL function, cognitive function and BPSD, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). These data were collected at baseline and six months later. Detailed data about antipsychotic prescribing were collected from prescription records. This study showed that 132 persons (38%) in the study population used antipsychotic drugs at the start of the study. Of these, 52/132 (39%) had prescriptions that followed national guidelines with regard to dose and substance. After six months, there were 111 of 132 persons left because of deaths and dropouts. Of these 111 people, 80 (72%) were still being treated with antipsychotics, 63/111 (57%) with the same dose. People who exhibited aggressive behavior (OR: 1.980, CI: 1.515-2.588), or passiveness (OR: 1.548, CI: 1.150-2.083), or had mild cognitive impairment (OR: 2.284 CI: 1.046-4.988), were at increased risk of being prescribed antipsychotics. The prevalence of antipsychotic drug use among people with dementia living in specialized care units was high and inappropriate long-term use of antipsychotic drugs was common.
    BMC pharmacology & toxicology 02/2013; 14(1):10. DOI:10.1186/2050-6511-14-10
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    • "Behavioural and psychological symptoms of dementia (BPSD) comprise a broad spectrum of non-cognitive symptoms including physical aggression, agitation, hallucinations, depression, delusions , wandering and sleep disturbances (Petrovic et al., 2007; Liperoti et al., 2008). Up to 80% of patients with Alzheimer's dementia may develop periodic episodes or chronic behavioural and psychological symptoms in their course of illness (Lyketsos et al., 2002). "
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    ABSTRACT: Within the treatment of dementia, management of behavioural and psychological symptoms (BPSD) is a complex component. We wanted to offer a pragmatic synthesis of existing specific practice recommendations for managing BPSD, based on agreement among systematically appraised dementia guidelines. We conducted a systematic search in MEDLINE and guideline organisation databases, supplemented by a hand search of web sites. Fifteen retrieved guidelines were eligible for quality appraisal by the Appraisal of Guidelines Research and Evaluation instrument (AGREE), performed by 2 independent reviewers. From the 5 included guidelines, 18 specific practice recommendations for BPSD were extracted and compared for their level of evidence and strength. No agreement was found among dementia guidelines for the majority of specific practice recommendations with regard to non-pharmacological interventions, although these were recommended as first-line treatment. Pharmacological specific practice recommendations were proposed as second-line treatment, with agreement for the use of a selection of antipsychotics based on strong supporting evidence, but with guidance for timely discontinuation. The appraisal of the level of agreement between guidelines for each specific practice recommendation was complicated by variation in grading systems, and was performed with criteria developed a posteriori. Despite the limited number of recommendations for which agreement was found, guidelines did agree on careful antipsychotic use for BPSD. Adverse events might outweigh the supporting evidence of efficacy, weakening the recommendation. More pivotal trials on the effectiveness of non-pharmacological interventions, as well as guidelines specifically focusing on BPSD, are needed.
    Ageing research reviews 08/2011; 11(1):78-86. DOI:10.1016/j.arr.2011.07.002 · 4.94 Impact Factor
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    • "Typically, these trials include a combination of measures evaluating cognition, clinicians’ and caregivers’ impression of change, functional abilities and behaviour. Pharmacological treatment of behavioural and psychological symptoms of dementia (BPSD) have been recently reviewed in this journal [77]. We will focus on cognitive, global, and functional outcomes. "
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    ABSTRACT: Alzheimer's disease (AD) is the most common neurodegenerative disorder. Worldwide prevalence of the disease is estimated at more than 24 million cases. With aging of populations, this number will likely increase to more than 80 million cases by the year 2040. The annual incidence worldwide is estimated at 4.6 million cases which is the equivalent of one new case every seven seconds! The pathophysiology of AD is complex and largely misunderstood. It is thought to start with the accumulation of beta-amyloid (αβ) that leads to deposition of insoluble neuritic or senile plaques. Secondary events in this "amyloid cascade" include hyperphosphorylation of the protein tau into neurofibrillary tangles, inflammation, oxidation, and excitotoxicity that eventually cause activation of apoptotis, cell death and neurotransmitter deficits. This review will briefly summarize recent advances in the pathophysiology of AD and focus on the pharmacological treatment of the cognitive and functional symptoms of AD. It will discuss the roles of vascular prevention, cholinesterase inhibitors and an NMDA-antagonist in the management of AD. It will address the issues thought to be related to the lack of persistence or discontinuation of therapy with cholinesterase inhibitors shown in recent studies and some of the solutions proposed. These include setting realistic expectations in light of a neurodegenerative condition and available symptomatic treatments, slowly titrating medications, and using alternate routes of administration. Finally, it will introduce future therapeutic options currently under study.
    DNA research: an international journal for rapid publication of reports on genes and genomes 03/2010; 8(1):69-80. DOI:10.2174/157015910790909520 · 3.05 Impact Factor
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