Challenge Your Knowledge
132 Questions
2 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common form of dementia?

  • Alzheimer's disease (correct)
  • Frontotemporal dementia
  • Lewy body dementia
  • Vascular dementia

    • What are Neuropsychiatric symptoms (NPSs)?

  • Symptoms that affect the immune system of patients with dementia
  • Symptoms that affect the mental abilities of patients with dementia (correct)
  • Symptoms that affect the physical abilities of patients with dementia
  • Symptoms that affect the sensory abilities of patients with dementia

    • What are the consequences of Neuropsychiatric symptoms (NPSs) in patients with dementia?

  • Increased socio-economic burden (correct)
  • Less severe caregiver burden
  • Later institutionalization
  • Longer life span

    • What do clinical treatment guidelines recommend for the treatment of Neuropsychiatric symptoms (NPSs) in dementia?

    <p>Non-pharmacological interventions</p> Signup and view all the answers

    What is the treatment algorithm for Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Pharmacological treatment is required only in definitive, urgent conditions</p> Signup and view all the answers

    What is the effectiveness of atypical antipsychotics (AAPs) in improving psychosis or agitation in patients with Alzheimer's disease according to the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) trial?

    <p>Not effective compared with a placebo</p> Signup and view all the answers

    What are the consequences of treatment-resistant Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Shorter life span</p> Signup and view all the answers

    What are non-pharmacological interventions for the treatment of Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Therapy</p> Signup and view all the answers

    What is the importance of elucidating the pathogeneses of treatment-resistant Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>To understand the mechanisms underlying treatment-resistant NPSs</p> Signup and view all the answers

    What model should be discussed to resolve the unknown mechanisms underlying treatment-resistant Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Bio-psychosocial-neurocognitive model</p> Signup and view all the answers

    What is the first-choice medicine for treating the crucial sub-symptoms of Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Antipsychotics</p> Signup and view all the answers

    What is the most common form of dementia?

    <p>Alzheimer's disease</p> Signup and view all the answers

    What are Neuropsychiatric symptoms (NPSs)?

    <p>Symptoms that affect the mental abilities of patients with dementia</p> Signup and view all the answers

    What do clinical treatment guidelines recommend for the treatment of Neuropsychiatric symptoms (NPSs) in dementia?

    <p>Non-pharmacological interventions</p> Signup and view all the answers

    What is the treatment algorithm for Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Pharmacological treatment is required only in definitive, urgent conditions</p> Signup and view all the answers

    What model should be discussed to resolve the unknown mechanisms underlying treatment-resistant Neuropsychiatric symptoms (NPSs) in patients with dementia?

    <p>Bio-psychosocial-neurocognitive model</p> Signup and view all the answers

    What are neuropsychiatric symptoms (NPSs)?

    <p>Symptoms that appear during the course of dementia such as psychosis, agitation, depression, and apathy</p> Signup and view all the answers

    What is the impact of NPSs on patients with dementia?

    <p>Shorter life span, earlier institutionalization, more severe caregiver burden, and increased socio-economic burden</p> Signup and view all the answers

    What is the treatment algorithm for NPSs in patients with dementia?

    <p>Definitive, urgent conditions for pharmacological treatment</p> Signup and view all the answers

    What is the effectiveness of atypical antipsychotics (AAPs) for improving psychosis or agitation in patients with Alzheimer's disease?

    <p>The effectiveness of AAPs is inconclusive</p> Signup and view all the answers

    Why do patients discontinue treatment during phase 1 of the CATIE-AD trial?

    <p>Due to the lack of efficacy of the medication</p> Signup and view all the answers

    Are non-pharmacological interventions for the treatment of NPSs effective?

    <p>No, they are relatively weak alternatives to pharmacological treatments</p> Signup and view all the answers

    What is the importance of elucidating the pathogeneses of NPSs that are difficult to treat pharmacologically?

    <p>To help clinicians and caregivers during discussions regarding long-term care plans and treatment strategies</p> Signup and view all the answers

    What model should be discussed to resolve the unknown mechanisms underlying treatment-resistant NPSs?

    <p>Bio-psychosocial-neurocognitive model</p> Signup and view all the answers

    What is the definition of treatment-resistant schizophrenia (TRS)?

    <p>Poor response despite adequate treatment</p> Signup and view all the answers

    What is the definition of treatment-resistant depression (TRD)?

    <p>Failure to achieve treatment response after at least two adequate trials of antidepressants</p> Signup and view all the answers

    What is pharmacological treatment-resistant NPSs in AD (p-TRENS-AD)?

    <p>Urgent sub-symptoms that are likely to respond poorly to pharmacological treatment</p> Signup and view all the answers

    Which of the following NPSs in AD are unlikely to respond to pharmacological treatment?

    <p>Wandering</p> Signup and view all the answers

    What are some factors that can contribute to the development of p-TRENS-AD?

    <p>All of the above</p> Signup and view all the answers

    What is necessary for the prescription of antipsychotics?

    <p>Optimal occupancy of striatal dopamine D2/3 receptors</p> Signup and view all the answers

    Do older patients with schizophrenia have a higher or lower therapeutic window than younger patients?

    <p>Lower</p> Signup and view all the answers

    How can changes in the central drug absorption system in the AD-affected brain affect antipsychotics?

    <p>Increase the affinity of antipsychotics to the D2/3 receptor</p> Signup and view all the answers

    How can cytochrome P450 isoforms affect drug treatment in AD patients?

    <p>Reduce drug clearance and contribute to adverse effects</p> Signup and view all the answers

    Can pharmacogenomics predict treatment response in AD patients with depression?

    <p>Yes</p> Signup and view all the answers

    What are the theoretical neuropharmacological mechanisms of NPSs in AD?

    <p>Involvement of monoaminergic neurons</p> Signup and view all the answers

    Can pharmacological treatment with antipsychotics accelerate apathy or motivation loss in AD patients?

    <p>Yes</p> Signup and view all the answers

    What is the definition of p-TRENS-AD?

    <p>Pharmacological treatment-resistant NPSs in AD</p> Signup and view all the answers

    What is the definition of TRS?

    <p>Treatment-resistant schizophrenia</p> Signup and view all the answers

    What is the definition of TRD?

    <p>Treatment-resistant depression</p> Signup and view all the answers

    Which NPSs in AD are unlikely to respond to pharmacological treatment?

    <p>Wandering, perseverative shouting, and some sexually inappropriate behaviors</p> Signup and view all the answers

    What factors can contribute to the development of p-TRENS-AD?

    <p>Biological and psychosocial factors</p> Signup and view all the answers

    What is the role of age-related alterations in pharmacokinetics in p-TRENS-AD?

    <p>Reduce drug clearance and contribute to adverse effects</p> Signup and view all the answers

    What is the optimal occupancy of striatal dopamine D2/3 receptors necessary for the prescription of antipsychotics?

    <p>High</p> Signup and view all the answers

    What changes in the central drug absorption system in the AD-affected brain may increase the affinity of antipsychotics to the D2/3 receptor?

    <p>Increases in permeability across the blood-brain barrier</p> Signup and view all the answers

    What may exacerbate undesirable effects via drug-drug interactions?

    <p>Cytochrome P450 isoforms</p> Signup and view all the answers

    What can pharmacogenomics predict in patients with major depressive disorder (MDD)?

    <p>Treatment response</p> Signup and view all the answers

    What are the theoretical neuropharmacological mechanisms of NPSs in AD?

    <p>Involvement of monoaminergic neurons</p> Signup and view all the answers

    What is the potential drawback of pharmacological treatment with antipsychotics for monoaminergic hyper-availability state leading to delusion and aggressiveness?

    <p>May tend to accelerate apathy or motivation loss</p> Signup and view all the answers

    What is pharmacological treatment-resistant NPSs in AD (p-TRENS-AD)?

    <p>Sub-symptoms that are likely to respond poorly to pharmacological treatment or for which pharmacological treatment is likely to be intolerable</p> Signup and view all the answers

    What is the definition of treatment-resistant schizophrenia (TRS)?

    <p>Poor response despite adequate treatment</p> Signup and view all the answers

    What is the definition of treatment-resistant depression (TRD)?

    <p>Failure to achieve treatment response after at least two adequate trials of antidepressants</p> Signup and view all the answers

    What are some sub-symptoms in AD that are unlikely to respond to pharmacological treatment?

    <p>Wandering, perseverative shouting, and some sexually inappropriate behaviors</p> Signup and view all the answers

    What factors can contribute to the development of p-TRENS-AD?

    <p>Biological and psychosocial factors</p> Signup and view all the answers

    How can age-related alterations in pharmacokinetics affect drug clearance?

    <p>Reduce drug clearance and contribute to adverse effects</p> Signup and view all the answers

    What is necessary for the prescription of antipsychotics?

    <p>An optimal occupancy of striatal dopamine D2/3 receptors</p> Signup and view all the answers

    What changes in the central drug absorption system in the AD-affected brain may lead to increased permeability across the blood-brain barrier?

    <p>Changes that increase the affinity of antipsychotics to the D2/3 receptor</p> Signup and view all the answers

    How can Cytochrome P450 isoforms affect drug-drug interactions?

    <p>Exacerbate undesirable effects</p> Signup and view all the answers

    What can pharmacogenomics predict in patients with major depressive disorder (MDD)?

    <p>Treatment response</p> Signup and view all the answers

    What are the theoretical neuropharmacological mechanisms of NPSs in AD?

    <p>Involvement of monoaminergic neurons, including the serotonergic dorsal raphe nucleus and the noradrenergic locus coeruleus</p> Signup and view all the answers

    What is the potential effect of pharmacological treatment with antipsychotics on monoaminergic hyper-availability state leading to delusion and aggressiveness?

    <p>May be effective</p> Signup and view all the answers

    What is the reason for treatment discontinuation in Alzheimer's disease?

    <p>Both lack of efficacy and adverse effects</p> Signup and view all the answers

    What approach is needed to reduce the risk of adverse effects in elderly people with Alzheimer's disease?

    <p>Start low, go slow</p> Signup and view all the answers

    What contributes to adverse effects in elderly patients with Alzheimer's disease?

    <p>All of the above</p> Signup and view all the answers

    What may increase the affinity of antipsychotics to the D2/3 receptor in Alzheimer's disease-affected brains?

    <p>Blood-brain barrier disruption</p> Signup and view all the answers

    What exacerbates adverse effects via drug-drug interactions in patients with Alzheimer's disease?

    <p>Concomitant use of multiple medicines</p> Signup and view all the answers

    What gene polymorphisms significantly predict antidepressant response in patients with major depressive disorder?

    <p>Candidate gene polymorphisms</p> Signup and view all the answers

    What has a better response to treatment for depression and anxiety in patients with Alzheimer's disease been associated with?

    <p>APOE-ε3 carriers</p> Signup and view all the answers

    Which metabolic genophenotypes of the CYP enzymes respond significantly better to current treatments for depression and anxiety in patients with Alzheimer's disease?

    <p>Normal metabolizer and intermediate metabolizer</p> Signup and view all the answers

    What is the difference between the theoretical neuropharmacological mechanism of psychosis in Alzheimer's disease and schizophrenia?

    <p>The relevance of the monoaminergic neurocircuitry</p> Signup and view all the answers

    What factors have been associated with the emergence of neuropsychiatric symptoms (NPS) in Alzheimer's disease?

    <p>Severe caregiver burden, housemate type, and comorbidities</p> Signup and view all the answers

    What may influence the occurrence of NPSs in Alzheimer's disease, causing interpersonal problems between patients and caregivers via psychopathological conflicts?

    <p>Psychosocial factors and demographic ones</p> Signup and view all the answers

    What can contribute indirectly to a reduction in the severity of NPS in patients with dementia?

    <p>Non-pharmacological interventions</p> Signup and view all the answers

    What is the reason for treatment discontinuation in Alzheimer's disease?

    <p>Adverse effects</p> Signup and view all the answers

    Why is a 'start low, go slow' approach needed for pharmacological treatments in elderly patients with Alzheimer's disease?

    <p>To reduce the risk of adverse effects</p> Signup and view all the answers

    What contributes to adverse effects in elderly patients with Alzheimer's disease?

    <p>Peripheral pharmacokinetics</p> Signup and view all the answers

    What changes occur in the central drug absorption system in the AD-affected brain?

    <p>Increased affinity of antipsychotics to the D2/3 receptor</p> Signup and view all the answers

    What exacerbates adverse effects in patients with AD?

    <p>Cytochrome P450 isoforms</p> Signup and view all the answers

    What predicts antidepressant response in patients with major depressive disorder?

    <p>Candidate gene polymorphisms</p> Signup and view all the answers

    What is associated with a better response to treatment for depression and anxiety in patients with AD?

    <p>APOE-ε3 carriers</p> Signup and view all the answers

    Which metabolic genophenotypes respond significantly better to current treatments for depression and anxiety in patients with AD?

    <p>Normal metabolizer and intermediate metabolizer</p> Signup and view all the answers

    What is the difference between the theoretical neuropharmacological mechanism of psychosis in AD and schizophrenia?

    <p>The monoaminergic neurocircuitry is more relevant in AD</p> Signup and view all the answers

    What factors have been associated with the emergence of neuropsychiatric symptoms (NPS) in AD?

    <p>Severe caregiver burden, housemate type, racial type, educational level, sex, marital status, residential situation, and comorbidities</p> Signup and view all the answers

    How do psychosocial and demographic factors influence the occurrence of NPS in AD?

    <p>They cause interpersonal problems between patients and caregivers</p> Signup and view all the answers

    How can comprehensive non-pharmacological interventions for cohabitant caregivers contribute to a reduction in the severity of NPS in patients with dementia?

    <p>By improving the psychological well-being of caregivers</p> Signup and view all the answers

    What is the reason for treatment discontinuation in Alzheimer's disease?

    <p>Adverse effects and lack of efficacy</p> Signup and view all the answers

    What approach is needed to reduce the risk of adverse effects in elderly patients with AD?

    <p>Start low, go slow</p> Signup and view all the answers

    How do age-related alterations in peripheral pharmacokinetics affect drug clearance?

    <p>Reduce drug clearance</p> Signup and view all the answers

    What changes in the central drug absorption system may increase the affinity of antipsychotics to the D2/3 receptor in the AD-affected brain?

    <p>Changes arising from the disruption of the blood-brain barrier</p> Signup and view all the answers

    What contributes to adverse effects via drug-drug interactions arising from the concomitant use of multiple medicines prescribed for lifestyle-related diseases in elderly patients with AD?

    <p>Cytochrome P450 isoforms</p> Signup and view all the answers

    What has been associated with a better response to treatment for depression and anxiety in patients with AD?

    <p>APOE-ε3 carriers</p> Signup and view all the answers

    What are the metabolic genophenotypes of the CYP enzymes?

    <p>Normal metabolizer, intermediate metabolizer, poor metabolizer, or ultra-rapid metabolizer</p> Signup and view all the answers

    Which patients with AD responded significantly better to current treatments for depression and anxiety?

    <p>NMs or IMs</p> Signup and view all the answers

    What is the theoretical neuropharmacological mechanism of psychosis in AD?

    <p>Subtly different from that for schizophrenia mainly because of the relevance of the monoaminergic neurocircuitry</p> Signup and view all the answers

    What factors have been associated with NPS emergence in AD?

    <p>Severe caregiver burden, housemate type, racial type, educational level, sex, marital status, residential situation, and comorbidities other than NPS sub-symptoms</p> Signup and view all the answers

    What may influence the occurrence of NPSs in AD, causing interpersonal problems between patients and caregivers via psychopathological conflicts?

    <p>The reciprocal relationship between psychosocial factors and demographic ones</p> Signup and view all the answers

    What can contribute indirectly to a reduction in the severity of NPS in patients with dementia?

    <p>Comprehensive non-pharmacological interventions for cohabitant caregivers</p> Signup and view all the answers

    What are some factors that may hinder treatment response to pharmacological interventions for neuropsychiatric symptoms in Alzheimer's disease?

    <p>Neglecting psychosocial and demographic factors</p> Signup and view all the answers

    What are some NPS sub-symptoms that can be caused by neurocognitive mechanisms in AD?

    <p>Apathy, disinhibition, and depression</p> Signup and view all the answers

    What is a potential consequence of poor self-awareness of cognitive symptoms and NPS in AD?

    <p>Refusal of care and delay treatment intervention</p> Signup and view all the answers

    What are some first-line approaches for reducing NPS severity in dementia?

    <p>Interpersonal and non-pharmacological interventions</p> Signup and view all the answers

    What is a potential benefit of relocating AD patients into specialized care units?

    <p>Improved treatment-resistant NPSs</p> Signup and view all the answers

    What is a potential alternative treatment for AD patients with apathy or depression?

    <p>Neuromodulation, including electric convulsive therapy and transcranial magnetic stimulation</p> Signup and view all the answers

    What is the placebo effect on NPS in AD patients?

    <p>Significant</p> Signup and view all the answers

    What are some potential side effects and risks of medications when treating NPS in AD patients?

    <p>Important to consider</p> Signup and view all the answers

    What is the potential benefit of reducing NPS in AD patients?

    <p>Improved quality of life for both patients and caregivers</p> Signup and view all the answers

    What are some non-pharmacological interventions that can be effective in reducing NPS?

    <p>Music therapy and behavioral interventions</p> Signup and view all the answers

    What is a potential drawback of continuation of antipsychotic drugs for treatment of psychosis or agitation in AD patients?

    <p>Deemed unfavorable in AD patients</p> Signup and view all the answers

    What is the potential benefit of long-term treatment strategies based on neurocognitive mechanisms for p-TRENS-AD?

    <p>Considered</p> Signup and view all the answers

    What is the first-line approach for reducing NPS severity in dementia?

    <p>Interpersonal and non-pharmacological interventions</p> Signup and view all the answers

    What is the placebo effect on NPS in AD patients?

    <p>Significant</p> Signup and view all the answers

    What are the main NPS in Alzheimer's disease?

    <p>Psychosis, agitation, and depression</p> Signup and view all the answers

    What can cause pessimistic ideation and suicidal behavior in AD patients?

    <p>Poor self-awareness of cognitive symptoms and NPS</p> Signup and view all the answers

    What is the CATIE-AD trial?

    <p>A trial investigating the effects of antipsychotic drugs on psychosis and agitation</p> Signup and view all the answers

    What is the recommended treatment for hallucinations and delusions in AD patients?

    <p>Antipsychotics</p> Signup and view all the answers

    What can hinder treatment response to pharmacological interventions for NPS in AD?

    <p>Neglecting psychosocial and demographic factors</p> Signup and view all the answers

    What percentage of reduction in NPS severity was observed in the placebo group of the CATIE-AD trial?

    <p>60-90%</p> Signup and view all the answers

    What can patient relocation into specialized care units improve in AD patients?

    <p>NPS sub-symptoms</p> Signup and view all the answers

    What are the potential risks of medications when treating NPS in AD patients?

    <p>Side effects</p> Signup and view all the answers

    What is the recommended treatment for depression and anxiety in AD patients?

    <p>Antidepressants</p> Signup and view all the answers

    What can hinder targeted treatment for complex NPS sub-symptoms in AD patients?

    <p>Neurocognitive mechanisms</p> Signup and view all the answers

    What are some factors that may hinder treatment response to pharmacological interventions for neuropsychiatric symptoms in AD?

    <p>Psychosocial and demographic factors</p> Signup and view all the answers

    What are some neuropsychiatric symptoms (NPS) commonly seen in AD patients?

    <p>Psychosis, agitation, and depression</p> Signup and view all the answers

    What are some non-pharmacological interventions that can be effective in reducing NPS in AD patients?

    <p>Music therapy and behavioral interventions</p> Signup and view all the answers

    What is the placebo effect on NPS in AD patients?

    <p>It can be significant</p> Signup and view all the answers

    What are some potential risks of medications when treating NPS in AD patients?

    <p>Increased risk of falls and fractures</p> Signup and view all the answers

    What are some first-line approaches for reducing NPS severity in dementia?

    <p>Interpersonal and non-pharmacological interventions</p> Signup and view all the answers

    What is CATIE-AD trial and what was its main finding?

    <p>A trial investigating the effects of antipsychotics on NPS</p> Signup and view all the answers

    What are some factors that can influence the presence of loneliness and other life changes in AD patients?

    <p>Gender differences</p> Signup and view all the answers

    What are some treatments for bipolar symptoms in AD patients?

    <p>Mood stabilizers</p> Signup and view all the answers

    What is p-TRENS-AD and what is the recommended treatment strategy for it?

    <p>A subtype of NPS in AD</p> Signup and view all the answers

    What are some alternative treatments for AD patients with apathy or depression?

    <p>Neuromodulation and cognitive behavioral therapy</p> Signup and view all the answers

    What is the potential benefit of reducing NPS in AD patients?

    <p>Improved quality of life for both patients and caregivers</p> Signup and view all the answers

    Study Notes

    Challenges in Pharmacological Treatment for Neuropsychiatric Symptoms in Patients with Dementia

    • The prevalence of patients with dementia worldwide is expected to reach about 152 million by 2050.
    • Alzheimer's disease is the most common form of dementia and is characterized by progressive neurocognitive impairments, leading to reductions in daily activities.
    • Neuropsychiatric symptoms (NPSs) such as psychosis, agitation, depression, and apathy appear during the course of dementia.
    • NPSs worsen patients' prognoses, resulting in a shorter life span, earlier institutionalization, more severe caregiver burden, and increased socio-economic burden.
    • Clinical treatment guidelines for NPSs in dementia recommend non-pharmacological interventions rather than pharmacological interventions.
    • The treatment algorithm for NPSs in patients with dementia requires definitive, urgent conditions for pharmacological treatment.
    • Antipsychotics have conventionally been presumed to be more effective than other medicines for improving psychosis or agitation in patients with AD.
    • The Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) trial could not show significant effectiveness of atypical antipsychotics (AAPs) compared with a placebo, and about 80% of patients discontinued treatment during phase 1 due to undesirable adverse effects or lack of efficacy.
    • The crucial sub-symptoms (psychosis, agitation, and depression) of NPSs that necessitate urgent pharmacological interventions tend to be difficult to treat, with the first-choice medicine often having to be switched to another drug.
    • Non-pharmacological interventions for the treatment of NPSs may be relatively weak alternatives to pharmacological treatments.
    • Elucidating the pathogeneses of NPSs that are difficult to treat pharmacologically may be helpful to clinicians and caregivers during discussions regarding long-term care plans and treatment strategies.
    • A bio-psychosocial-neurocognitive model should be discussed to resolve the unknown mechanisms underlying treatment-resistant NPSs, including delusional misidentification and apathy.

    Pharmacological Treatment-Resistant Neuropsychiatric Symptoms in Alzheimer's Disease: Definition and Hypothetical Pathogenesis

    • Pharmacological treatment difficulties have been defined in patients with mental disorders, but not in those with neuropsychiatric symptoms (NPSs) in Alzheimer's disease (AD).
    • Treatment-resistant schizophrenia (TRS) is defined as poor response despite adequate treatment, while treatment-resistant depression (TRD) is defined as failure to achieve treatment response after at least two adequate trials of antidepressants.
    • Pharmacological treatment-resistant NPSs in AD (p-TRENS-AD) refers to urgent sub-symptoms that are likely to respond poorly to pharmacological treatment or for which pharmacological treatment is likely to be intolerable.
    • Sub-symptoms such as wandering, perseverative shouting, and some sexually inappropriate behaviors are unlikely to respond to pharmacological treatment.
    • Biological and psychosocial factors can contribute to the development of p-TRENS-AD.
    • Age-related alterations in pharmacokinetics can reduce drug clearance and contribute to adverse effects.
    • An optimal occupancy of striatal dopamine D2/3 receptors is necessary for the prescription of antipsychotics, but older patients with schizophrenia may have a lower therapeutic window than younger patients.
    • Changes in the central drug absorption system in the AD-affected brain may increase the affinity of antipsychotics to the D2/3 receptor, leading to increased permeability across the blood-brain barrier.
    • Cytochrome P450 isoforms may exacerbate undesirable effects via drug-drug interactions.
    • Pharmacogenomics can predict treatment response in patients with major depressive disorder (MDD), but other factors may influence the subsequent prognosis in AD patients with depression.
    • Theoretical neuropharmacological mechanisms of NPSs in AD involve the involvement of monoaminergic neurons, including the serotonergic dorsal raphe nucleus and the noradrenergic locus coeruleus.
    • Pharmacological treatment with antipsychotics may be effective against monoaminergic hyper-availability state leading to delusion and aggressiveness, but may tend to accelerate apathy or motivation loss.

    Factors Influencing Treatment Response in Elderly Patients with Alzheimer's Disease

    • Treatment discontinuation in Alzheimer's disease (AD) is due to adverse effects and lack of efficacy, leading to the need for alternative medications.
    • Elderly people may have difficulty tolerating pharmacological treatments, and a "start low, go slow" approach is needed to reduce the risk of adverse effects.
    • Age-related alterations in peripheral pharmacokinetics reduce drug clearance, contributing to adverse effects.
    • Within the AD-affected brain, changes in the central drug absorption system arising from the disruption of the blood-brain barrier may increase the affinity of antipsychotics to the D2/3 receptor.
    • Cytochrome P450 isoforms may exacerbate adverse effects via drug-drug interactions arising from the concomitant use of multiple medicines prescribed for lifestyle-related diseases.
    • Antidepressant response in patients with major depressive disorder is significantly predicted by candidate gene polymorphisms, but not associated with CYP genes.
    • A better response to treatment for depression and anxiety in patients with AD has been associated with APOE-ε3 carriers.
    • The metabolic genophenotypes of the CYP enzymes can be classified as normal metabolizer, intermediate metabolizer, poor metabolizer, or ultra-rapid metabolizer, and patients with AD who were classified as NMs or IMs responded significantly better to current treatments for depression and anxiety than those who were classified as PMs or UMs.
    • The theoretical neuropharmacological mechanism of psychosis in AD is subtly different from that for schizophrenia mainly because of the relevance of the monoaminergic neurocircuitry.
    • Severe caregiver burden, housemate type, racial type, educational level, sex, marital status, residential situation, and comorbidities other than NPS sub-symptoms have been associated with NPS emergence.
    • The reciprocal relationship between psychosocial factors and demographic ones may influence the occurrence of NPSs in AD, causing interpersonal problems between patients and caregivers via psychopathological conflicts.
    • Comprehensive non-pharmacological interventions for cohabitant caregivers can contribute indirectly to a reduction in the severity of NPS in patients with dementia.

    Strategies for Treating Treatment-Resistant Neuropsychiatric Symptoms in Alzheimer's Disease

    • Neglecting psychosocial and demographic factors may hinder treatment response to pharmacological interventions for neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD).

    • Gender differences in AD patients can influence the presence of cohabitant and marital status, which may be associated with loneliness and other life changes.

    • Neurocognitive mechanisms in AD can cause complex NPS sub-symptoms, including apathy, disinhibition, and depression, hindering targeted treatment.

    • The severity and frequency of cognitive decline in AD patients can influence NPS sub-symptoms and treatment response.

    • Poor self-awareness of cognitive symptoms and NPS in AD can lead to refusal of care and delay treatment intervention, while preserved self-awareness can cause pessimistic ideation and suicidal behavior.

    • Neurocognitive progression in AD can induce subsequent neuropsychiatric problems via functional reductions, complex mechanisms, and poor self-awareness.

    • Interpersonal and non-pharmacological interventions are first-line approaches for reducing NPS severity in dementia.

    • Patient relocation into specialized care units with appropriate facilities and staff can improve treatment-resistant NPSs in AD.

    • Augmentation or combination therapy with antidepressants or antipsychotics may be helpful for treating depressive mood in AD patients with psychosis.

    • Neuromodulation, including electric convulsive therapy and transcranial magnetic stimulation, may be effective alternative treatments for AD patients with apathy or depression.

    • The placebo effect on NPS in AD patients can be significant, and the severity of main NPS sub-symptoms can be reduced by almost half in long-term treatment courses.

    • Long-term treatment strategies based on neurocognitive mechanisms should be considered for p-TRENS-AD, and an exit strategy should be discussed.Reduction of Neuropsychiatric Symptoms in Alzheimer's Disease

    • Main neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) include psychosis, agitation, and depression.

    • In the CATIE-AD trial, continuation of antipsychotic drugs for treatment of psychosis or agitation was deemed unfavorable in AD patients.

    • Overall severity of NPS, based on Neuropsychiatric Inventory (NPI) score, decreased by 50% after 36 weeks, including both active and placebo groups.

    • Placebo group in CATIE-AD trial experienced a decrease in NPI score from 27.5 ± 17.1 to 11.6 ± 12.6 points.

    • Two large randomized controlled trials (RCTs) investigating the effects of antidepressants on depression, anxiety, and agitation have shown reductions in placebo groups.

    • Reductions in agitation in placebo groups were about 60-90% at 9 weeks, and reductions in depression were about 63% at 39 weeks.

    • Severity of NPS may decrease in a "time-dependent manner" regardless of medication intake.

    • NPS sub-symptoms require different treatments, such as mood stabilizers for bipolar symptoms, antipsychotics for hallucinations and delusions, and antidepressants for depression and anxiety.

    • Studies have shown that non-pharmacological interventions, such as music therapy and behavioral interventions, can also be effective in reducing NPS.

    • It is important to consider potential side effects and risks of medications when treating NPS in AD patients.

    • The reduction of NPS can lead to improved quality of life for both patients and caregivers.

    • More research is needed to better understand the underlying mechanisms of NPS in AD and to develop more effective treatments.

    Strategies for Treating Treatment-Resistant Neuropsychiatric Symptoms in Alzheimer's Disease

    • Neglecting psychosocial and demographic factors may hinder treatment response to pharmacological interventions for neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD).

    • Gender differences in AD patients can influence the presence of cohabitant and marital status, which may be associated with loneliness and other life changes.

    • Neurocognitive mechanisms in AD can cause complex NPS sub-symptoms, including apathy, disinhibition, and depression, hindering targeted treatment.

    • The severity and frequency of cognitive decline in AD patients can influence NPS sub-symptoms and treatment response.

    • Poor self-awareness of cognitive symptoms and NPS in AD can lead to refusal of care and delay treatment intervention, while preserved self-awareness can cause pessimistic ideation and suicidal behavior.

    • Neurocognitive progression in AD can induce subsequent neuropsychiatric problems via functional reductions, complex mechanisms, and poor self-awareness.

    • Interpersonal and non-pharmacological interventions are first-line approaches for reducing NPS severity in dementia.

    • Patient relocation into specialized care units with appropriate facilities and staff can improve treatment-resistant NPSs in AD.

    • Augmentation or combination therapy with antidepressants or antipsychotics may be helpful for treating depressive mood in AD patients with psychosis.

    • Neuromodulation, including electric convulsive therapy and transcranial magnetic stimulation, may be effective alternative treatments for AD patients with apathy or depression.

    • The placebo effect on NPS in AD patients can be significant, and the severity of main NPS sub-symptoms can be reduced by almost half in long-term treatment courses.

    • Long-term treatment strategies based on neurocognitive mechanisms should be considered for p-TRENS-AD, and an exit strategy should be discussed.Reduction of Neuropsychiatric Symptoms in Alzheimer's Disease

    • Main neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) include psychosis, agitation, and depression.

    • In the CATIE-AD trial, continuation of antipsychotic drugs for treatment of psychosis or agitation was deemed unfavorable in AD patients.

    • Overall severity of NPS, based on Neuropsychiatric Inventory (NPI) score, decreased by 50% after 36 weeks, including both active and placebo groups.

    • Placebo group in CATIE-AD trial experienced a decrease in NPI score from 27.5 ± 17.1 to 11.6 ± 12.6 points.

    • Two large randomized controlled trials (RCTs) investigating the effects of antidepressants on depression, anxiety, and agitation have shown reductions in placebo groups.

    • Reductions in agitation in placebo groups were about 60-90% at 9 weeks, and reductions in depression were about 63% at 39 weeks.

    • Severity of NPS may decrease in a "time-dependent manner" regardless of medication intake.

    • NPS sub-symptoms require different treatments, such as mood stabilizers for bipolar symptoms, antipsychotics for hallucinations and delusions, and antidepressants for depression and anxiety.

    • Studies have shown that non-pharmacological interventions, such as music therapy and behavioral interventions, can also be effective in reducing NPS.

    • It is important to consider potential side effects and risks of medications when treating NPS in AD patients.

    • The reduction of NPS can lead to improved quality of life for both patients and caregivers.

    • More research is needed to better understand the underlying mechanisms of NPS in AD and to develop more effective treatments.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge on the challenges in pharmacological treatment for neuropsychiatric symptoms in patients with dementia. This quiz covers the prevalence of dementia, the impact of neuropsychiatric symptoms on patient prognosis, the effectiveness of pharmacological interventions, and non-pharmacological alternatives. You will also learn about the pathogeneses of difficult-to-treat symptoms and the importance of a bio-psychosocial-neurocognitive model in treatment strategies. Keywords: dementia, neuropsychiatric symptoms, pharmacological treatment,

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser