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: 1.93). 05/2010; 22(3):346-72. DOI: 10.1017/S1041610209991505
Source: PubMed


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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    • "BPSD are found in all types of dementia and are among the core symptoms, in addition to cognitive decline and impaired activities of daily living (Finkel, 2000; Finkel et al., 1996). For instance, 80e97% of the AD patients in the general population suffer from one or more BPSD at some point during their disease (Gauthier et al., 2010). Jost and Grossberg (1996) investigated the temporal relationship between BPSD and the clinical diagnosis of AD and showed that particular BPSD can be acquired before, around or after the AD diagnosis. "
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    ABSTRACT: Behavioural and Psychological Symptoms of Dementia (BPSD) are a core symptom of dementia and are associated with suffering, earlier institutionalization and accelerated cognitive decline for patients and increased caregiver burden. Despite the extremely high risk for Down syndrome (DS) individuals to develop dementia due to Alzheimer's disease (AD), BPSD have not been comprehensively assessed in the DS population. Due to the great variety of DS cohorts, diagnostic methodologies, sub-optimal scales, covariates and outcome measures, it is questionable whether BPSD have always been accurately assessed. However, accurate recognition of BPSD may increase awareness and understanding of these behavioural aberrations, thus enabling adaptive caregiving and, importantly, allowing for therapeutic interventions. Particular BPSD can be observed (long) before clinical dementia diagnosis and could therefore serve as early indicators of those at risk, and provide a new, non-invasive way to monitor, or at least give an indication of, the complex progression to dementia in DS. Therefore, this review summarizes and evaluates the rather limited knowledge on BPSD in DS and highlights its importance and potential for daily clinical practice.
    Cortex 08/2015; 73:36-61. DOI:10.1016/j.cortex.2015.07.032 · 5.13 Impact Factor
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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. · 1.96 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 · 2.87 Impact Factor
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