Management of behavioral problems in Alzheimer's disease

Alzheimer's Disease and Related Disorders Unit, McGill Center for Studies in Aging, Douglas Mental Health University Institute, Montreal, Canada.
International Psychogeriatrics (Impact Factor: 1.89). 05/2010; 22(3):346-72. DOI: 10.1017/S1041610209991505
Source: PubMed

ABSTRACT Alzheimer's disease (AD) is a complex progressive brain degenerative disorder that has effects on multiple cerebral systems. In addition to cognitive and functional decline, diverse behavioral changes manifest with increasing severity over time, presenting significant management challenges for caregivers and health care professionals. Almost all patients with AD are affected by neuropsychiatric symptoms at some point during their illness; in some cases, symptoms occur prior to diagnosis of the dementia syndrome. Further, behavioral factors have been identified, which may have their origins in particular neurobiological processes, and respond to particular management strategies. Improved clarification of causes, triggers, and presentation of neuropsychiatric symptoms will guide both research and clinical decision-making. Measurement of neuropsychiatric symptoms in AD is most commonly by means of the Neuropsychiatric Inventory; its utility and future development are discussed, as are the limitations and difficulties encountered when quantifying behavioral responses in clinical trials. Evidence from clinical trials of both non-pharmacological and pharmacological treatments, and from neurobiological studies, provides a range of management options that can be tailored to individual needs. We suggest that non-pharmacological interventions (including psychosocial/psychological counseling, interpersonal management and environmental management) should be attempted first, followed by the least harmful medication for the shortest time possible. Pharmacological treatment options, such as antipsychotics, antidepressants, anticonvulsants, cholinesterase inhibitors and memantine, need careful consideration of the benefits and limitations of each drug class.

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Available from: George T Grossberg, Aug 05, 2015
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    • "In this respect, the utilisation of only a global BPSD score to detect clinical changes over time following an intervention in AD patients has been questioned (Gauthier et al., 2010). Several authors instead recommended the observation of each symptom included in a multi-symptom neuropsychiatric instrument in order to measure properly the impact of an intervention on BPSD (Robert et al., 2005, 2010). "
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    ABSTRACT: The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on 12 behavioural and psychological symptoms of dementia (BPSD) in patients with mild to moderate Alzheimer's disease (AD). This six-month single-blind block-randomised cross-over controlled study was conducted with 15 mild to moderate AD participants and their caregivers. All participants received a four-week home-based cognitive rehabilitation programme to learn/re-learn an instrumental activity of daily living. They were assessed up until three months following the end of the intervention. The Neuropsychiatric Inventory (NPI-12) was employed to evaluate patients' BPSD at seven assessment points during the course of the study. A general linear mixed model analysis performed on the NPI data revealed that aberrant motor behaviours (AMB) increased significantly more in the treatment condition than in the control condition. In addition, both groups registered a significant reduction of delusional symptoms during the second half of the study. Employing a multi-symptom approach to assess participants' BPSD, this cross-over randomised controlled study showed that an individualised cognitive rehabilitation intervention was generally well-tolerated by mild to moderate AD patients. Future cognitive rehabilitation studies conducted with this population should pay attention to AMB symptom changes. First 50 copies free at :
    Neuropsychological Rehabilitation 09/2014; In press. DOI:10.1080/09602011.2014.964731. · 2.07 Impact Factor
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    • "In AD, our findings indicate that interventions that aim to optimize self-reported HRQoL may benefit from focusing on areas other than primarily cognitive function, such as, symptoms of anxiety and depression (Tatsumi et al., 2009; Bosboom et al., 2012; Bosboom et al., 2013; Cooper et al., 2013). A large proportion of people with AD are affected by BPSD at some point during the course of their illness, and evidence from clinical trials of both non-pharmacological and pharmacological treatments provides a range of multidisciplinary management options that can be tailored to individual needs (Wolfs et al., 2008; Gauthier et al., 2010). Current findings support the recommendation that improving our management of BPSD might favorably affect the HRQoL of people with mild to moderate AD and, possibly, contribute to delay the transition from home to residential care (Wolfs et al., 2008). "
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    ABSTRACT: Currently available pharmacological treatments in Alzheimer's disease (AD) have been associated with modest benefits to cognition, but the impact on health-related quality of life (HRQoL) is less well established. Our aim was to determine if decline of specific cognitive functions commonly associated with AD predict which patients maintain or experience a deterioration of their HRQoL over 18 months. We completed an 18-month longitudinal study of 47 community-dwelling older adults diagnosed with probable AD of mild or moderate severity (NINCDS-ADRD criteria) and their family carers. The primary outcomes of interest were 18-month change in self-reported and carer-reported ratings on the quality of life-AD (QoL-AD). The main explanatory variables were 18-month change in specific cognitive functions using a broad range of established tests. Because of multiple comparisons, alpha was set at 1%. Twenty six of 47 and 20/47 participants with AD showed evidence of stable or increased QoL-AD over 18 months according to self report and carer report. Logistic regression analyses showed that for every increase in one standardized score of California Verbal Learning Test-II short delay free recall the odds of stable/increased self-rated QoL-AD over 18 months were 0.27 (95%CI: 0.11, 0.67; p = 0.005). After adjustment for anxiety and depression, this inverse association no longer met the study criteria for statistical significance (adjusted OR: 0.31, 95%CI: 0.11, 0.86; p = 0.025). None of the other standardized changes of cognitive scores were associated with self-rated or carer-rated QoL-AD grouping. Changes in specific cognitive functions are not associated with changes in HRQoL ratings in AD. Findings suggest that interventions that limit their focus to improving cognitive functions of people with mild to moderate AD living in the community might fail to have an impact on participants' HRQoL. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 07/2014; 29(7). DOI:10.1002/gps.4050 · 3.09 Impact Factor
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    • "ith ADRD before , during , and after a hurricane . Packing clothing and other preparations activities might cause anxiety about leaving their familiar environment . Thus , plans might be best minimally discussed until right before leaving . Multiple sources cite music , for instance , as an effective activity for stress reduction and redirection ( Gauthier et al . , 2010 ; Hulme , Wright , Crocker , Oluboyede , & House , 2010 ; Raglio et al . , 2008 ) . Social workers and other professionals can encourage caregivers to include a battery - powered radio or other type of audio player in their disaster kits . Including songs enjoyable for the person with ADRD during car long rides and traffic associated wi"
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    ABSTRACT: Abstract This study examined disaster preparedness and decision-making by caregivers of community-dwelling persons diagnosed with Alzheimer's or a related dementia (ADRD). Interviews were conducted with 20 caregivers in South Florida. Twelve of these interviews include caregiving experiences during the highly active 2004-2005 hurricane seasons. Results indicate that persons in earlier stages of ADRD can, and often do, remain engaged in the disaster preparation and planning process. However, during the early stages, persons may also resist evacuation, even if the caregiver felt it was necessary. During later stages of the disease, caregivers reported less resistance to disaster-related decisions, however, with the tradeoff of less ability to assist with preparation.
    Journal of Gerontological Social Work 06/2014; 57(8). DOI:10.1080/01634372.2014.898009
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