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Phutietsile GO, Fotaki N, Jamieson HA, Nishtala PS. The association between anticholinergic burden and mobility: a systematic review and meta-analyses. BMC Geriatr 2023; 23:161. [PMID: 36949391 PMCID: PMC10035151 DOI: 10.1186/s12877-023-03820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND As people age, they accumulate several health conditions, requiring the use of multiple medications (polypharmacy) to treat them. One of the challenges with polypharmacy is the associated increase in anticholinergic exposure to older adults. In addition, several studies suggest an association between anticholinergic burden and declining physical function in older adults. OBJECTIVE/PURPOSE This systematic review aimed to synthesise data from published studies regarding the association between anticholinergic burden and mobility. The studies were critically appraised for the strength of their evidence. METHODS A systematic literature search was conducted across five electronic databases, EMBASE, CINAHL, PSYCHINFO, Cochrane CENTRAL and MEDLINE, from inception to December 2021, to identify studies on the association of anticholinergic burden with mobility. The search was performed following a strategy that converted concepts in the PECO elements into search terms, focusing on terms most likely to be found in the title and abstracts of the studies. For observational studies, the risk of bias was assessed using the Newcastle Ottawa Scale, and the Cochrane risk of bias tool was used for randomised trials. The GRADE criteria was used to rate confidence in evidence and conclusions. For the meta-analyses, we explored the heterogeneity using the Q test and I2 test and the publication bias using the funnel plot and Egger's regression test. The meta-analyses were performed using Jeffreys's Amazing Statistics Program (JASP). RESULTS Sixteen studies satisfied the inclusion criteria from an initial 496 studies. Fifteen studies identified a significant negative association of anticholinergic burden with mobility measures. One study did not find an association between anticholinergic intervention and mobility measures. Five studies included in the meta-analyses showed that anticholinergic burden significantly decreased walking speed (0.079 m/s ± 0.035 MD ± SE,95% CI: 0.010 to 0.149, p = 0.026), whilst a meta-analysis of four studies showed that anticholinergic burden significantly decreased physical function as measured by three variations of the Instrumental Activities of Daily Living (IADL) instrument 0.27 ± 0.12 (SMD ± SE,95% CI: 0.03 to 0.52), p = 0.027. The results of both meta-analyses had an I2 statistic of 99% for study heterogeneity. Egger's test did not reveal publication bias. CONCLUSION There is consensus in published literature suggesting a clear association between anticholinergic burden and mobility. Consideration of cognitive anticholinergic effects may be important in interpreting results regarding the association of anticholinergic burden and mobility as anticholinergic drugs may affect mobility through cognitive effects.
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Affiliation(s)
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, BA2 7AY, UK
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK
- Centre for Therapeutic Innovation, University of Bath, Bath, BA2 7AY, UK
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2
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Phiri P, Engelthaler T, Carr H, Delanerolle G, Holmes C, Rathod S. Associated mortality risk of atypical antipsychotic medication in individuals with dementia. World J Psychiatry 2022; 12:298-307. [PMID: 35317344 PMCID: PMC8900589 DOI: 10.5498/wjp.v12.i2.298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/24/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antipsychotic medications such as risperidone, olanzapine and aripiprazole are used to treat psychological and behavioural symptoms among dementia patients. Current evidence indicate prescription rates for antipsychotics vary and wider consensus to evaluate clinical epidemiological outcomes is limited.
AIM To investigate the potential impact of atypical antipsychotics on the mortality of patients with dementia.
METHODS A retrospective clinical cohort study was developed to review United Kingdom Clinical Record Interactive Search system based data between January 1, 2013 to December 31, 2017. A descriptive statistical method was used to analyse the data. Mini Mental State Examination (MMSE) scores were used to assess the severity and stage of disease progression. A cox proportional hazards model was developed to evaluate the relationship between survival following diagnosis and other variables.
RESULTS A total of 1692 patients were identified using natural language processing of which, 587 were prescribed olanzapine, quetiapine or risperidone (common group) whilst 893 (control group) were not prescribed any antipsychotics. Patients prescribed olanzapine showed an increased risk of death [hazard ratio (HR) = 1.32; 95% confidence interval (CI): 1.08-1.60; P < 0.01], as did those with risperidone (HR = 1.35; 95%CI: 1.18-1.54; P < 0.001). Patients prescribed quetiapine showed no significant association (HR = 1.09; 95%CI: 0.90-1.34; P = 0.38). Factors associated with a lower risk of death were: High MMSE score at diagnosis (HR = 0.72; 95%CI: 0.62-0.83; P < 0.001), identifying as female (HR = 0.73; 95%CI: 0.64-0.82; P < 0.001), and being of a White-British ethnic group (HR = 0.82; 95%CI: 0.72-0.94; P < 0.01).
CONCLUSION A significant mortality risk was identified among those prescribed olanzapine and risperidone which contradicts previous findings although the study designs used were different. Comprehensive research should be conducted to better assess clinical epidemiological outcomes associated with diagnosis and therapies to improve clinical management of these patients.
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Affiliation(s)
- Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, United Kingdom
| | - Tomas Engelthaler
- Oxford Centre for Innovation, Akrivia Health, Oxford OX1 BY, United Kingdom
| | - Hannah Carr
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Department of Psychology, University of Southampton, Southampton SO16 5ST, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Clive Holmes
- Clinical and Experimental Sciences, University of Southampton, Southampton SO16 5ST, United Kingdom
- Research & Innovation Department, Memory Assessment & Research Centre, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Shanaya Rathod
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
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Abstract
The prevalence of dementia is expected to rise with the aging of our population for decades to come. Neuropsychiatric symptoms of dementia, also known as behavioral and psychologic symptoms of dementia, are extremely common. Symptoms are most prevalent in the moderate stages of the disease, often increase with advancing disease stage, and often more than one symptom is present. These symptoms can cause a great deal of distress for patients and families, and take a toll on society as well. Evaluation and management can be challenging, with nonpharmacologic strategies recommended as first-line approach. There is growing evidence for specific pharmacologic strategies, but these come with significant risk, such that informed consent with the patient and surrogate decision maker is critical. In this chapter, we focus on general principles of etiology, assessment, and management, and then turn to individual symptoms of agitation, psychosis, apathy, sleep disturbance, and feeding and eating problems more specifically. Depression and anxiety are covered elsewhere in this text.
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Affiliation(s)
- Rebecca Radue
- Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Geriatric Research, Education and Clinic Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Art Walaszek
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
| | - Sanjay Asthana
- Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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4
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BozkurtZincir S, Ozdilek BF, Zincir S. Association of quetiapine with ischemic brain stem stroke: a case report and discussion. Ther Adv Psychopharmacol 2015; 5:246-9. [PMID: 26301082 PMCID: PMC4535042 DOI: 10.1177/2045125315583819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Selma BozkurtZincir
- Associate Professor of Psychiatry, Erenkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Betul F Ozdilek
- Associate Professor of Neurology, Erenkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
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Moretti R, Torre P, Antonello RM, Pizzolato G. Atypical neuroleptics as a treatment of agitation and anxiety in Alzheimer’s disease: risks or benefits. Expert Rev Neurother 2014; 6:705-10. [PMID: 16734518 DOI: 10.1586/14737175.6.5.705] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Behavioral problems produce excess disability that can be potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisias. On examination of the consequences of adverse events, somnolence, as well as postural instability and postural hypotension, have been noted. All patients with Alzheimer's disease (AD) and other progressive dementias will advance through stages of moderate-to-severe AD unless effective treatments suspend transition from mild deterioration to dementia, or competitive mortality truncates survival. Treatment trials suggest that these patients respond to both disease-modifying (such as inhibitors of cholinesterase and butirrylcholinesterase) and symptomatic (such as neuroleptics) agents. Relatively few studies have been conducted in this patient population, and more information regarding the type of behavioral disturbances exhibited, how best to measure them in this disabled population and their optimum treatment are urgently needed.
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Affiliation(s)
- Rita Moretti
- Università di Trieste, Dipartimento di Medicina Clinica e Neurologia, UCO di Neurologia dell'Università degli Studi di Trieste, Ospedale di Cattinara, 34149 Trieste, Italy.
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6
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A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia. Int Psychogeriatr 2014; 26:19-37. [PMID: 24103643 DOI: 10.1017/s1041610213001658] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population. METHODS A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia. RESULTS Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14). CONCLUSION A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.
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Shin JY, Choi NK, Jung SY, Lee J, Kwon JS, Park BJ. Risk of ischemic stroke with the use of risperidone, quetiapine and olanzapine in elderly patients: a population-based, case-crossover study. J Psychopharmacol 2013; 27:638-44. [PMID: 23535349 DOI: 10.1177/0269881113482530] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted a case-crossover study to evaluate the comparative risk of ischemic stroke associated with the use of risperidone, quetiapine and olanzapine in geriatric patients using the Korean Health Insurance Review and Assessment Service database. Cases included elderly patients >64 years old who had experienced their first ischemic stroke (International Classification of Disease, Tenth Revision (ICD-10), I63) hospitalization from July 2005 to June 2006 and who had been without prior cerebrovascular diseases (ICD-10, I60-I69), or transient ischemic attack (ICD-10, G45). Exposures to risperidone, quetiapine and olanzapine were assessed during the 30 days prior to the stroke episode. We set two control periods with lengths which were the same as the hazard periods. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. A total of 1601 cases of ischemic stroke with a mean age of 75.6 (±6.7) years were identified, among which 933 (58.3%) were female. An increased risk of ischemic stroke was associated with the use of risperidone (aOR=3.5, 95% CI 3.3-4.6) and quetiapine (aOR=2.7, 95% CI 2.0-3.6) during the 30 days prior to stroke: however, no significant risk was observed with olanzapine (aOR=1.2, 95% CI 0.7-2.0). The increased stroke risk in demented patients, assessed within 30 days after exposure, was also observed with olanzapine. However, the sample of olanzapine users was small and underpowered.
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Affiliation(s)
- Ju-Young Shin
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
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8
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Chan MC, Chong CSY, Wu AYK, Wong KC, Dunn ELW, Tang OWN, Chan WF. Antipsychotics and risk of cerebrovascular events in treatment of behavioural and psychological symptoms of dementia in Hong Kong: a hospital-based, retrospective, cohort study. Int J Geriatr Psychiatry 2010; 25:362-70. [PMID: 19650162 DOI: 10.1002/gps.2347] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the risk of cerebrovascular adverse events (CVAEs) in patients with behavioural and psychological symptoms of dementia (BPSD) treated with typical or atypical antipsychotics in Hong Kong METHOD This was a retrospective cohort study. Patients aged 65 or above, diagnosed with Alzheimer's disease, vascular or mixed dementia, and first attended the psychiatric service of our unit between 1st January 2000 to 30th June 2007 were studied. The patients were divided into three groups according to their antipsychotic usage. They were compared on sociodemographic and clinical characteristics. The risk of CVAEs was studied by means of Cox regression analysis. RESULTS The studied cohort consisted of 1089 patients. The antipsychotic non-user, typical and atypical users groups consisted of 363, 654 and 72 patients, respectively. Incidence rate of CVAE for the three groups were 44.6/1000, 32.7/1000 and 49.6/1000 person years, respectively. The risk of developing CVAEs did not differ in typical or atypical antipsychotic user groups compared with non-user group. The adjusted hazard ratio of typical and atypical antipsychotic user groups were 0.964 (95% CI = 0.584-1.591) and 1.036 (95% CI = 0.350-3.066), respectively. Subgroup analyses of individual antipsychotic did not show a significant increase in risk of CVAEs. CONCLUSION This study showed that there was no statistical difference in risk of cerebrovascular events in treatment of BPSD with typical and atypical antipsychotics compared with non-user group. Nonetheless, given the side effects of antipsychotics, prescription of antipsychotics should be reserved for severe and distressing symptoms with careful consideration.
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Affiliation(s)
- Man-chak Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
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9
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Passmore MJ, Gardner DM, Polak Y, Rabheru K. Alternatives to atypical antipsychotics for the management of dementia-related agitation. Drugs Aging 2008; 25:381-98. [PMID: 18447403 DOI: 10.2165/00002512-200825050-00003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Numerous recent studies have challenged the widely held belief that atypical antipsychotics are safe and effective options for the treatment of behavioural problems such as agitation in patients with dementia. Accordingly, there is a need to reconsider the place of atypical antipsychotics in the treatment of patients with dementia. The present article is intended to assist clinicians with the assessment and pharmacological management of agitation in patients with dementia. We review the risk-benefit evidence for the use of atypical antipsychotics in patients with dementia-related agitation (DRA). Emerging evidence indicates that, for patients with dementia, the risks associated with atypical antipsychotics may outweigh the benefits except for patients with severe agitation who require short-term chemical restraint. We then discuss the importance of a careful assessment to rule out potentially reversible factors contributing to DRA. Finally, we summarize the evidence supporting the use of medications other than antipsychotics to treat DRA. There is wide variability in the levels of evidence supporting the use of non-antipsychotic medication for the treatment of DRA. The best evidence currently exists for cholinesterase inhibitors and serotonin-specific reuptake inhibitor antidepressants. Emerging reports suggest that numerous other medications, for example, antiepileptics, lithium, anxiolytics, analgesics, beta-adrenoceptor antagonists, cannabinoid receptor agonists and hormonal agents, may prove to be viable alternatives to antipsychotics for the treatment of severe DRA and more research is urgently needed to help assess the effectiveness of these agents. A comprehensive biopsychosocial assessment and treatment plan is likely the most effective way to manage DRA.
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Affiliation(s)
- Michael J Passmore
- Department of Psychiatry, Division of Geriatric Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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10
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Omerovic M, Hampel H, Teipel SJ, Buerger K. Pharmacological treatment of Alzheimer's dementia: state of the art and current dilemmas. World J Biol Psychiatry 2008; 9:69-75. [PMID: 17886162 DOI: 10.1080/15622970701568412] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Alzheimer's disease (AD) is one of the most frequent disorders of the central nervous system characterised by a progressive cognitive decline. The demographic changes of our aging population lead to increased numbers of patients and a need of early diagnosis and treatment of cognitive and behavioural symptoms of AD. Drugs are available for symptomatic treatment of AD. The pharmacological treatment of behavioural disturbances experienced dynamic changes in the last years. In this paper, we present the current state and future perspectives in the treatment of AD. Furthermore, we discuss current difficulties regarding AD treatment by looking for explanations for a still unsatisfying rate of state-of-the-art treatment of AD-patients.
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Affiliation(s)
- Muamer Omerovic
- Dementia Research Section and Memory Clinic, Alzheimer Memorial Center and Geriatric Psychiatry Branch, Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
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11
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Abstract
Zusammenfassung. Die frontotemporale Demenz ist nach der Alzheimer-Krankheit die zweithäufigste Ursache einer präsenilen Demenz. Die FTD ist vor allem durch einen schleichenden Beginn, einen progredienten Verlauf und eine frühe Veränderung des Verhaltens gekennzeichnet. Daneben treten Symptome wie Antriebsmangel, Agitation, stereotypes Verhalten, kognitive Beeinträchtigung und Sprachstörungen auf. Über die Therapie der FTD gibt es bisher nur wenige systematische Studien, die jedoch darauf hindeuten, dass vor allem selektive Serotonin-Wiederaufnahme-Hemmer (so genannte SSRI) bei Verhaltensstörungen wirksam sind. Außerdem ist ein individuell abgestimmtes nichtmedikamentöses Vorgehen sinnvoll, das beispielsweise der Antriebssteigerung oder der Verminderung aggressiver Handlungstendenzen dienen soll.
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Affiliation(s)
- Robert Perneczky
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München
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12
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Marshall GA, Cummings JL. Neuropsychiatric evaluation in dementia. HANDBOOK OF CLINICAL NEUROLOGY 2008; 89:53-61. [PMID: 18631730 DOI: 10.1016/s0072-9752(07)01204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Gad A Marshall
- Harvard Medical School and Memory Disorders Unit, Brigham and Women's Hospital, Boston, MA 02115, USA.
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13
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Moretti R, Torre P, Antonello RM, Vilotti C, Pizzolato G. New treatment options for vascular dementia. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/1745509x.3.2.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Clinical trials performed in patients defined as affected by vascular dementia have so far achieved unsatisfactory results. Recently, preliminary results have been published demonstrating a generally stable performance in cognitive tasks, with a slightly better performance in executive functions and a better behavioral response, in a group of subcortical vascular dementia patients treated with rivastigmine. A recent proposal is that vascular dementia is not an univocal and unique pathology: the etiopathogenesis of multi-infarct dementia is quite different to that of subcortical vascular dementia. Future studies need to consider those entities separately to obtain good results for a group of patients for whom, until now, there have been few therapeutic options. The aim of this review is to summarize the consolidated notions, perspectives and new therapeutic options to better define the possible future treatment of vascular dementia.
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Affiliation(s)
- Rita Moretti
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Paola Torre
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Rodolfo M Antonello
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Cristina Vilotti
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
| | - Gilberto Pizzolato
- University of Trieste, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy
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14
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2006; 21:500-7. [PMID: 16739260 DOI: 10.1002/gps.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Generali J. Recent Publications on Medications and Pharmacy. Hosp Pharm 2006. [DOI: 10.1310/hpj4101-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this new feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics. Suggestions or comments may be addressed to Joyce Generali, Director of Drug Information at Kansas University Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 or jgeneral@kumc.edu .
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Affiliation(s)
- Joyce Generali
- Drug Information Center, Kansas University Medical Center, Kansas City, KS
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17
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Lanari A, Amenta F, Silvestrelli G, Tomassoni D, Parnetti L. Neurotransmitter deficits in behavioural and psychological symptoms of Alzheimer's disease. Mech Ageing Dev 2005; 127:158-65. [PMID: 16297434 DOI: 10.1016/j.mad.2005.09.016] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 05/17/2005] [Accepted: 09/15/2005] [Indexed: 11/28/2022]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) occur in 50-90% of Alzheimer's disease (AD) patients. Imbalance of different neurotransmitters (acetylcholine, dopamine, noradrenaline and serotonin), involvement of specific brain regions responsible for emotional activities (parahippocampal gyrus, dorsal raphe and locus coeruleus) and cortical hypometabolism have been proposed as neurobiological substrate of BPSD. Compared to with respect to the neurochemical component, the cholinergic dysfunction seems to play a major role in contributing to BPSD occurrence. This view is also supported by the findings of recent trials with cholinesterase inhibitors, showing that these drugs are effective in controlling and/or improving BPSD, independent on effects on cognitive dysfunction. On the site of psychotropic drugs, atypical or novel antipsychotics represent the reference drugs for treating BPSD, whereas classic antipsychotic drugs for their profile and the potential side effects should be avoided.
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Affiliation(s)
- Alessia Lanari
- Dipartimento di Neuroscienze, Università di Perugia, Perugia, Italy
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18
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Aarsland D, Sharp S, Ballard C. Psychiatric and behavioral symptoms in Alzheimer’s disease and other dementias: Etiology and management. Curr Neurol Neurosci Rep 2005; 5:345-54. [PMID: 16131417 DOI: 10.1007/s11910-005-0058-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Psychiatric and behavioral symptoms are common in all types of dementia and have important consequences for patients, caregivers, and society. This paper reviews recent studies of the etiology and management of these symptoms. Genetic and neurochemical studies indicate that cholinergic, serotonergic, and dopaminergic systems may influence the risk of psychiatric symptoms in patients with dementia. There is still no consensus regarding the management of such symptoms. Controlled studies of psychosocial interventions, usually performed in the nursing home setting, report encouraging results. Atypical antipsychotics may be effective in some cases but have a high risk of adverse events. There is emerging evidence that cholinesterase inhibitors may reduce and prevent such symptoms. More studies are needed to clarify the role of cholinergic and other psychotropic agents as well as nonpharmacologic interventions for psychiatric and behavioral symptoms in patients with dementia.
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Affiliation(s)
- Dag Aarsland
- Centre for Clinical Neuroscience Research, Stavanger University Hospital, PO Box 1163, 4095 Stavanger, Norway.
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