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Wang HJ, Chinna-Meyyappan A, Feldman OJ, Lanctôt KL. Emerging therapies for treatment of agitation, psychosis, or apathy in Alzheimer's disease. Expert Opin Emerg Drugs 2024:1-15. [PMID: 38822731 DOI: 10.1080/14728214.2024.2363215] [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: 03/18/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Agitation, psychosis, and apathy are prevalent and highly distressing neuropsychiatric symptoms (NPS) of Alzheimer's disease (AD) that have been linked to numerous negative outcomes, including increased mortality, worsened cognitive decline, and caregiver burden. Current treatments for AD-associated agitation, namely atypical antipsychotics, provide some benefits but may increase the risk of serious adverse events and death. Meanwhile, no pharmacotherapies have been approved by regulatory agencies for the treatment of psychosis or apathy in AD. Over the past decade, many new and repurposed drugs have emerged as potential therapeutic options for managing these challenging NPS. AREAS COVERED This review aims to provide a comprehensive summary of pharmacotherapies that have recently been investigated in phase 2 and 3 clinical trials for the treatment of agitation, psychosis, or apathy in AD. EXPERT OPINION Novel atypical antipsychotics, serotonergic antidepressants, cannabinoids, and dextromethorphan combination drugs have shown promising results for alleviating agitation. Pimavanserin appears to be the most effective emerging therapy for psychosis, while methylphenidate has demonstrated good efficacy for apathy. Further research on biomarkers of NPS severity and treatment response, as well as continued improvements in methodological approaches are needed to advance the field.
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Affiliation(s)
- Hui Jue Wang
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Arun Chinna-Meyyappan
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Oriel J Feldman
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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2
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Iqbal I, Saqib F, Mubarak Z, Latif MF, Wahid M, Nasir B, Shahzad H, Sharifi-Rad J, Mubarak MS. Alzheimer's disease and drug delivery across the blood-brain barrier: approaches and challenges. Eur J Med Res 2024; 29:313. [PMID: 38849950 PMCID: PMC11161981 DOI: 10.1186/s40001-024-01915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
Alzheimer's disease (AD) is a diverse disease with a complex pathophysiology. The presence of extracellular β-amyloid deposition as neuritic plaques and intracellular accumulation of hyper-phosphorylated tau as neurofibrillary tangles remain the core neuropathologic criteria for diagnosing Alzheimer's disease. Nonetheless, several recent basic discoveries have revealed significant pathogenic roles for other essential cellular and molecular processes. Previously, there were not so many disease-modifying medications (DMT) available as drug distribution through the blood-brain barrier (BBB) is difficult due to its nature, especially drugs of polypeptides nature and proteins. Recently FDA has approved lecanemab as DMT for its proven efficacy. It is also complicated to deliver drugs for diseases like epilepsy or any brain tumor due to the limitations of the BBB. After the advancements in the drug delivery system, different techniques are used to transport the medication across the BBB. Other methods are used, like enhancement of brain blood vessel fluidity by liposomes, infusion of hyperosmotic solutions, and local intracerebral implants, but these are invasive approaches. Non-invasive approaches include the formulation of nanoparticles and their coating with polymers. This review article emphasizes all the above-mentioned techniques, procedures, and challenges to transporting medicines across the BBB. It summarizes the most recent literature dealing with drug delivery across the BBB.
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Affiliation(s)
- Iram Iqbal
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
- Primary and Secondary Healthcare Department, Govt of the Punjab, Lahore, Pakistan
| | - Fatima Saqib
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan.
| | - Zobia Mubarak
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
- Primary and Secondary Healthcare Department, Govt of the Punjab, Lahore, Pakistan
| | - Muhammad Farhaj Latif
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muqeet Wahid
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Bushra Nasir
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Hamna Shahzad
- Department of Biochemistry, Bahauddin Zakariya University Multan, Multan, Pakistan
| | - Javad Sharifi-Rad
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea.
| | - Mohammad S Mubarak
- Department of Chemistry, The University of Jordan, Amman, 11942, Jordan.
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3
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Huang YY, Gan YH, Yang L, Cheng W, Yu JT. Depression in Alzheimer's Disease: Epidemiology, Mechanisms, and Treatment. Biol Psychiatry 2024; 95:992-1005. [PMID: 37866486 DOI: 10.1016/j.biopsych.2023.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 10/07/2023] [Indexed: 10/24/2023]
Abstract
Depression and Alzheimer's disease (AD) are substantial public health concerns. In the past decades, a link between the 2 disease entities has received extensive acknowledgment, yet the complex nature of this relationship demands further clarification. Some evidence indicates that midlife depression may be an AD risk factor, while a chronic course of depression in late life may be a precursor to or symptom of dementia. Recently, multiple pathophysiological mechanisms have been proposed to underlie the bidirectional relationship between depression and AD, including genetic predisposition, immune dysregulation, accumulation of AD-related biomarkers (e.g., amyloid-β and tau), and alterations in brain structure. Accordingly, numerous therapeutic approaches, such as pharmacology treatments, psychotherapy, and lifestyle interventions, have been suggested as potential means of interfering with these pathways. However, the current literature on this topic remains fragmented and lacks a comprehensive review characterizing the association between depression and AD. In this review, we aim to address these gaps by providing an overview of the co-occurrence and temporal relationship between depression and AD, as well as exploring their underlying mechanisms. We also examine the current therapeutic regimens for depression and their implications for AD management and outline key challenges facing the field.
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Affiliation(s)
- Yu-Yuan Huang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Han Gan
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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4
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Chen Y, Al-Nusaif M, Li S, Tan X, Yang H, Cai H, Le W. Progress on early diagnosing Alzheimer's disease. Front Med 2024; 18:446-464. [PMID: 38769282 DOI: 10.1007/s11684-023-1047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/15/2023] [Indexed: 05/22/2024]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that affects both cognition and non-cognition functions. The disease follows a continuum, starting with preclinical stages, progressing to mild cognitive and behavioral impairment, ultimately leading to dementia. Early detection of AD is crucial for better diagnosis and more effective treatment. However, the current AD diagnostic tests of biomarkers using cerebrospinal fluid and/or brain imaging are invasive or expensive, and mostly are still not able to detect early disease state. Consequently, there is an urgent need to develop new diagnostic techniques with higher sensitivity and specificity during the preclinical stages of AD. Various non-cognitive manifestations, including behavioral abnormalities, sleep disturbances, sensory dysfunctions, and physical changes, have been observed in the preclinical AD stage before occurrence of notable cognitive decline. Recent research advances have identified several biofluid biomarkers as early indicators of AD. This review focuses on these non-cognitive changes and newly discovered biomarkers in AD, specifically addressing the preclinical stages of the disease. Furthermore, it is of importance to explore the potential for developing a predictive system or network to forecast disease onset and progression at the early stage of AD.
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Affiliation(s)
- Yixin Chen
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Murad Al-Nusaif
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Song Li
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Xiang Tan
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Huijia Yang
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Huaibin Cai
- Transgenic Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China.
- Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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5
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Kim D, Choi YR, Lee YN, Chang SO. Nurses' Shared Subjectivity on Person-Centered Care for Behavioral and Psychological Symptoms of Dementia in Nursing Homes. J Nurs Res 2024; 32:e330. [PMID: 38727209 DOI: 10.1097/jnr.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Person-centered care (PCC), an approach to healthcare that focuses on the individual needs, preferences, and values of patients, is particularly important in the context of caring for residents of nursing homes (NHs) with the behavioral and psychological symptoms of dementia (BPSD). However, implementing PCC in NHs varies widely due to individual staff, NH environment, and country factors, leading to heterogeneity in person-centered approaches. PURPOSE This study was designed to explore and gain insight into the shared subjective perspectives of nurses on providing PCC to manage BPSD in NHs in order to elicit a deeper understanding of how nurses interpret and approach the provision of PCC. METHODS Q methodology was applied to explore the subjective perspectives of nurses. Twenty-nine NH nurses with more than 3 years of experience in managing BPSD completed a Q-sorting task, categorizing 43 Q-samples into a normal distribution shape. Postsorting interviews were conducted after the participants had completed this task. The collected data were analyzed using centroid factor analysis and varimax rotation run within the PQMethod 2.35 program. Interpretation of the resulting factors was based on factor arrays, field notes, and interview data. RESULTS Four factors from the shared subjective perspectives of nurses related to PCC were identified, including (a) sharing information focused on details to update care strategies, (b) monitoring until the true needs of residents are identified, (c) awareness of interactive cues in relationships, and (d) connecting an individual's life pattern to their current care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings highlight that a one-size-fits-all approach may not be suitable for all nurses and interventions, indicating that nurses should consider the applicable subjective frames to ensure the effectiveness of planned interventions. A need for PCC education that specifically addresses BPSD management is suggested, with the findings implying that a strong organizational climate with respect to PCC in managing BPSD should promote higher job satisfaction and commitment and reduce turnover rates among nurses in NHs. Facilitating the development of PCC interventions appropriate for BPSD management that encompass the various categories and ranges of NH settings and nursing phenomena is thus recommended.
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Affiliation(s)
- Dayeong Kim
- MSN, RN, Doctoral Student, College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Republic of Korea
| | - Young-Rim Choi
- PhD, RN, Research Professor, College of Nursing, Korea University, Republic of Korea
| | - Ye-Na Lee
- PhD, RN, Assistant Professor, Department of Nursing, The University of Suwon, Republic of Korea
| | - Sung Ok Chang
- PhD, RN, Professor, College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Republic of Korea
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6
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Fernandes S, von Gunten A, Verloo H. Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review. JMIR Nurs 2024; 7:e54496. [PMID: 38805252 PMCID: PMC11167323 DOI: 10.2196/54496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.
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Affiliation(s)
- Sofia Fernandes
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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7
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Mercier C, Rollason V, Eshmawey M, Mendes A, Frisoni GB. The treatment of behavioural and psychological symptoms in dementia: pragmatic recommendations. Psychogeriatrics 2024. [PMID: 38638077 DOI: 10.1111/psyg.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) are a clinical challenge for the lack of a sound taxonomy, frequent presentation with comorbid BPSD, lack of specific pharmacologic interventions, poor base of methodologically sound evidence with randomized clinical trials, contamination from the treatment of behavioural disturbances of young and adult psychiatric conditions, and small efficacy window of psychotropic drugs. We present here a treatment workflow based on a concept-driven literature review based on the notions that (i) the aetiology of BPSD can be mainly neurobiological (so-called 'primary' symptoms) or mainly environmental and functional ('secondary' symptoms) and that this drives treatment; (ii) the clinical efficacy of psychotropic drugs is driven by their specific profile of receptor affinity; (iii) drug treatment should follow the rules of 'start low-go slow, prescribe and revise'. This article argues in support of the distinction between primary and secondary BPSD, as well as their characteristics, which until now have been just sketchily described in the literature. It also offers comprehensive and pragmatic clinician-oriented recommendations for the treatment of BPSD.
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Affiliation(s)
- Camille Mercier
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Department of Acute Medicine, Clinical Pharmacology and Toxicology Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Mohamed Eshmawey
- Department of Psychiatry, Geriatric Psychiatry Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Aline Mendes
- Geriatrics and Rehabilitation Department, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
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Kim JS, Hong SB, Park KW, Lee ATC. Psychotic Symptoms in Patients With Major Neurological Diseases. J Clin Neurol 2024; 20:153-165. [PMID: 38433485 PMCID: PMC10921039 DOI: 10.3988/jcn.2023.0501] [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: 12/11/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024] Open
Abstract
Neurological diseases often manifest with neuropsychiatric symptoms such as depression, emotional incontinence, anger, apathy and fatigue. In addition, affected patients may also experience psychotic symptoms such as hallucinations and delusions. Various factors contribute to the development of psychotic symptoms, and the mechanisms of psychosis are similar, but still differ among various neurological diseases. Although psychotic symptoms are uncommon, and have been less well investigated, they may annoy patients and their families as well as impair the patients' quality of life and increase the caregiver burden. Therefore, we need to appropriately identify and treat these psychotic symptoms in patients with neurological diseases.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Seung-Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun-Woo Park
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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9
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Levenson S. Antipsychotics: Past, Present, and Future (Part 2): Article 2 of 3. Sr Care Pharm 2024; 39:57-72. [PMID: 38263570 DOI: 10.4140/tcp.n.2024.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
The history of antipsychotics in nursing facilities is one piece of a much larger, more complex puzzle. In many ways, it reflects the virtues and limitations of the entire health care system and those who provide care. None of the issues related to the use of antipsychotics are specific to these medications or to nursing facilities. After decades of effort to reduce unwarranted antipsychotics use, the current situation is still a work in progress. Many widely held assumptions and standard narratives, such as those about behavior, the place of medications in person-centered care, and the causes of inappropriate medication use are only partially correct. This second of three articles is not intended to discuss how to diagnose and manage behavior disorders or choose medications. Instead, it addresses the diverse perspectives and key players that have been involved and the results of their efforts. Ultimately, this will set the stage for specific recommendations (part 3) about learning from past efforts surrounding antipsychotics to identify more definitive and lasting improvements in the future. Part 1 of this series covered the history of attempts to influence use of medications-especially, antipsychotics-in nursing facility care of residents with behavior, mood, and cognitive issues. These improvement efforts can be described as fragmented, often ineffectual, and politically fraught. After decades of effort, and despite a significant reduction in the indiscriminate use of antipsychotics, psychotropics are still widely used in nursing facilities.1 The extent of improvement overall in managing individuals with dementia and other diverse behavior, mood, and cognitive issues is unclear.
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10
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Pyka P, Haberek W, Więcek M, Szymanska E, Ali W, Cios A, Jastrzębska-Więsek M, Satała G, Podlewska S, Di Giacomo S, Di Sotto A, Garbo S, Karcz T, Lambona C, Marocco F, Latacz G, Sudoł-Tałaj S, Mordyl B, Głuch-Lutwin M, Siwek A, Czarnota-Łydka K, Gogola D, Olejarz-Maciej A, Wilczyńska-Zawal N, Honkisz-Orzechowska E, Starek M, Dąbrowska M, Kucwaj-Brysz K, Fioravanti R, Nasim MJ, Hittinger M, Partyka A, Wesołowska A, Battistelli C, Zwergel C, Handzlik J. First-in-Class Selenium-Containing Potent Serotonin Receptor 5-HT 6 Agents with a Beneficial Neuroprotective Profile against Alzheimer's Disease. J Med Chem 2024; 67:1580-1610. [PMID: 38190615 PMCID: PMC10823479 DOI: 10.1021/acs.jmedchem.3c02148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Abstract
Alzheimer's disease (AD) has a complex and not-fully-understood etiology. Recently, the serotonin receptor 5-HT6 emerged as a promising target for AD treatment; thus, here a new series of 5-HT6R ligands with a 1,3,5-triazine core and selenoether linkers was explored. Among them, the 2-naphthyl derivatives exhibited strong 5-HT6R affinity and selectivity over 5-HT1AR (13-15), 5-HT7R (14 and 15), and 5-HT2AR (13). Compound 15 displayed high selectivity for 5-HT6R over other central nervous system receptors and exhibited low risk of cardio-, hepato-, and nephrotoxicity and no mutagenicity, indicating its "drug-like" potential. Compound 15 also demonstrated neuroprotection against rotenone-induced neurotoxicity as well as antioxidant and glutathione peroxidase (GPx)-like activity and regulated antioxidant and pro-inflammatory genes and NRF2 nuclear translocation. In rats, 15 showed satisfying pharmacokinetics, penetrated the blood-brain barrier, reversed MK-801-induced memory impairment, and exhibited anxiolytic-like properties. 15's neuroprotective and procognitive-like effects, stronger than those of the approved drug donepezil, may pave the way for the use of selenotriazines to inhibit both causes and symptoms in AD therapy.
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Affiliation(s)
- Patryk Pyka
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
- Division
of Bioorganic Chemistry, School of Pharmacy, Saarland University, Campus B 2.1, D-66123 Saarbrücken, Germany
- Doctoral
School of Medical and Health Sciences, Jagiellonian
University Medical College, św. Łazarza 15, 31-530 Kraków, Poland
| | - Wawrzyniec Haberek
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
- Division
of Bioorganic Chemistry, School of Pharmacy, Saarland University, Campus B 2.1, D-66123 Saarbrücken, Germany
- Doctoral
School of Medical and Health Sciences, Jagiellonian
University Medical College, św. Łazarza 15, 31-530 Kraków, Poland
| | - Małgorzata Więcek
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Ewa Szymanska
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Wesam Ali
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
- Division
of Bioorganic Chemistry, School of Pharmacy, Saarland University, Campus B 2.1, D-66123 Saarbrücken, Germany
| | - Agnieszka Cios
- Department
of Clinical Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Magdalena Jastrzębska-Więsek
- Department
of Clinical Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Grzegorz Satała
- Department
of Medicinal Chemistry, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Sabina Podlewska
- Department
of Medicinal Chemistry, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Silvia Di Giacomo
- Department
of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Italian
National Institute of Health (ISS), Viale Regina Elena 299, 00161 Rome, Italy
| | - Antonella Di Sotto
- Department
of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Sabrina Garbo
- Department
of Molecular Medicine, Istituto Pasteur Italia, Fondazione Cenci-Bolognetti, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Tadeusz Karcz
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Chiara Lambona
- Department
of Drug Chemistry and Technologies, Sapienza
University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Francesco Marocco
- Department
of Molecular Medicine, Istituto Pasteur Italia, Fondazione Cenci-Bolognetti, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Gniewomir Latacz
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Sylwia Sudoł-Tałaj
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
- Doctoral
School of Medical and Health Sciences, Jagiellonian
University Medical College, św. Łazarza 15, 31-530 Kraków, Poland
| | - Barbara Mordyl
- Department
of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Monika Głuch-Lutwin
- Department
of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Agata Siwek
- Department
of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Kinga Czarnota-Łydka
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
- Doctoral
School of Medical and Health Sciences, Jagiellonian
University Medical College, św. Łazarza 15, 31-530 Kraków, Poland
| | - Dawid Gogola
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
- Doctoral
School of Medical and Health Sciences, Jagiellonian
University Medical College, św. Łazarza 15, 31-530 Kraków, Poland
| | - Agnieszka Olejarz-Maciej
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Natalia Wilczyńska-Zawal
- Department
of Clinical Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Ewelina Honkisz-Orzechowska
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Małgorzata Starek
- Department
of Inorganic and Analytical Chemistry, Jagiellonian
University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Monika Dąbrowska
- Department
of Inorganic and Analytical Chemistry, Jagiellonian
University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Katarzyna Kucwaj-Brysz
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Rossella Fioravanti
- Department
of Drug Chemistry and Technologies, Sapienza
University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Muhammad Jawad Nasim
- Division
of Bioorganic Chemistry, School of Pharmacy, Saarland University, Campus B 2.1, D-66123 Saarbrücken, Germany
| | - Marius Hittinger
- Department
of Drug Discovery, Pharmbiotec gGmbH, Nußkopf 39, 66578 Schiffweiler, Germany
- Department
of Drug Delivery, Pharmbiotec gGmbH, Nußkopf 39, 66578 Schiffweiler, Germany
| | - Anna Partyka
- Department
of Clinical Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Anna Wesołowska
- Department
of Clinical Pharmacy, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Cecilia Battistelli
- Department
of Molecular Medicine, Istituto Pasteur Italia, Fondazione Cenci-Bolognetti, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Clemens Zwergel
- Division
of Bioorganic Chemistry, School of Pharmacy, Saarland University, Campus B 2.1, D-66123 Saarbrücken, Germany
- Department
of Drug Chemistry and Technologies, Sapienza
University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Department
of Drug Discovery, Pharmbiotec gGmbH, Nußkopf 39, 66578 Schiffweiler, Germany
| | - Jadwiga Handzlik
- Department
of Technology and Biotechnology of Drugs, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
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11
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Levenson S. Antipsychotics in Perspective: Past, Present, and Future (Article 2 of 3). J Am Med Dir Assoc 2024; 25:S1525-8610(23)00954-4. [PMID: 38300201 DOI: 10.1016/j.jamda.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024]
Abstract
The history of antipsychotics in nursing homes is one piece of a much larger, more complex puzzle. In many ways, it reflects the virtues and limitations of the entire health care system and those who provide care. None of the issues related to the use of antipsychotics are specific to these medications or to nursing homes. After decades of effort to reduce unwarranted antipsychotics use, the current situation is still a work in progress. Many widely held assumptions and standard narratives, such as those about behavior, the place of medications in person-centered care, and the causes of inappropriate medication use are only partially correct. This second of 3 articles is not intended to discuss how to diagnose and manage behavior disorders or choose medications. Instead, it addresses the diverse perspectives and key players that have been involved and the results of their efforts. Ultimately, this will set the stage for specific recommendations (part 3) about learning from past efforts surrounding antipsychotics to identify more definitive and lasting improvements in the future.
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12
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Kim D, Choi YR, Lee YN, Chang SO. How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study. Nurs Health Sci 2024. [PMID: 38163765 DOI: 10.1111/nhs.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Young-Rim Choi
- Research professor, College of Nursing, Korea University, Seoul, Republic of Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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13
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Cations M, Atee M, Morris T, Whiting D. Neuropsychiatric symptoms of dementia in those with and without a recorded history of psychological trauma: A comparative study from an Australian dementia support service. Int J Geriatr Psychiatry 2024; 39:e6054. [PMID: 38185811 PMCID: PMC10952246 DOI: 10.1002/gps.6054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/30/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To compare the number and severity of neuropsychiatric symptoms (NPS) and associated caregiver distress between those with and without a noted history of psychological trauma among those referred to a specialised national dementia NPS support service. METHODS This was a 5-year retrospective observational study of records from the Dementia Support Australia NPS support service. NPS were reported by formal or informal caregivers at service entry using the Neuropsychiatric Inventory Nursing Home version or Questionnaire version. A history of psychological trauma was recorded in the person's social or medical history and/or endorsed as a contributor to NPS by a trained dementia consultant after a comprehensive clinical review. Regression was used to examine the impact of a recorded history of psychological trauma on NPS severity and associated caregiver distress, controlling for age and sex. RESULTS Among 41,876 eligible referrals with dementia, 6% (n = 2529) had some reference in their records to a history of psychological trauma. Referrals with a recorded history of psychological trauma were rated with a higher rate of both NPS severity (mean = 12.0) and associated caregiver distress (mean = 16.5) at service entry than those without a recorded history of psychological trauma (means = 10.7 and 14.5, respectively). A recorded history of psychological trauma was associated with higher odds of psychotic symptoms, agitation/aggression, irritability, disinhibition, affective symptoms and night-time behaviours. CONCLUSIONS Traumatic stress symptoms may represent a neglected target for intervention to reduce the impact of NPS in people with dementia.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social WorkFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Mustafa Atee
- The Dementia CentreHammondCareOsborne ParkWestern AustraliaAustralia
- Faculty of Health SciencesCurtin Medical SchoolCurtin UniversityBentleyWestern AustraliaAustralia
- Faculty of Medicine and HealthSydney Pharmacy SchoolThe University of SydneySydneyNew South WalesAustralia
- Centre for Research in Aged CareSchool of Nursing and MidwiferyEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Thomas Morris
- The Dementia CentreHammondCareSt LeonardsNew South WalesAustralia
- Faculty of Medicine and HealthSydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Daniel Whiting
- The Dementia CentreHammondCareSt LeonardsNew South WalesAustralia
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14
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Cai H, Du R, Yang K, Li W, Wang Z. Bibliometric Analysis of the Research Status and Global Trends in Behavioral and Psychological Symptoms of Dementia in Alzheimer's Disease from 2002 to 2022. Curr Neuropharmacol 2024; 22:1720-1732. [PMID: 37550906 DOI: 10.2174/1570159x21666230807144750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Several reviews on behavioral and psychological symptoms (BPSDs) in patients with Alzheimer's disease (AD) have summarized the current state of this field, but global trends are unclear. OBJECTIVE This study utilized CiteSpace to provide a global overview of the current state of research on AD and its BPSDs and to predict future research trends in the field. METHODS Data were retrieved from the Web of Science Core Collection. Bibliometric and cooccurrence analyses were performed using CiteSpace software. In total, 787 valid publications were included in the analysis. RESULTS Publications on AD and BPSD have shown an increasing trend since 2002. The United States and the University of Toronto were the countries and institutions with the highest total number of publications, respectively. Japan and China were the second and third most influential in the field. Clive Ballard was the top author in terms of the number of publications. Journal of Alzheimer's Disease had the highest number of publications on this topic. Co-occurrence analysis showed that AD, behavioral symptoms, cognitive impairment, and early markers are hot topics in this area. Non-drug management of BPSDs, pharmacological treatment, and physiotherapy will be a hot topic in this field in the future. CONCLUSION Our study visualized the relevant articles over the past 21 years to detect global hotspots and trends. Our findings may help researchers to identify research hotspots in this field and will help in the selection of appropriate research topics, while possibly leading to cross-regional cooperation.
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Affiliation(s)
- Haipeng Cai
- Beijing Huilongguan Hospital, Huilongguan Clinical Medical School of Peking University, Beijing, China
| | - Ruonan Du
- Beijing Huilongguan Hospital, Huilongguan Clinical Medical School of Peking University, Beijing, China
| | - Kebing Yang
- Beijing Huilongguan Hospital, Huilongguan Clinical Medical School of Peking University, Beijing, China
| | - Wei Li
- Beijing Huilongguan Hospital, Huilongguan Clinical Medical School of Peking University, Beijing, China
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Huilongguan Clinical Medical School of Peking University, Beijing, China
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15
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Teixeira AL, Rocha NP, Gatchel J. Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1152-1162. [PMID: 38157881 PMCID: PMC10756775 DOI: 10.1055/s-0043-1777774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.
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Affiliation(s)
- Antonio Lucio Teixeira
- University of Texas University of Texas Health Science Center, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Houston, Texas, United States.
- Faculdade Santa Casa Belo Horizonte, Belo Horizonte MG, Brazil.
| | - Natalia Pessoa Rocha
- University of Texas Health Science Center, McGovern Medical School, Department of Neurology, Houston, Texas, United States.
| | - Jennifer Gatchel
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts, United States.
- Baylor College of Medicine, Department of Psychiatry, Houston, Texas, United States.
- Michael E. Debakey VA Medical Center, Houston, Texas, United States.
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16
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Kauzor K, Drewel M, Gonzalez H, Rattinger GB, Hammond AG, Wengreen H, Lyketsos CG, Tschanz JT. Malnutrition and neuropsychiatric symptoms in dementia: the Cache County Dementia Progression Study. Int Psychogeriatr 2023; 35:653-663. [PMID: 37246509 PMCID: PMC10592578 DOI: 10.1017/s1041610223000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Among people with dementia, poor nutritional status has been associated with worse cognitive and functional decline, but few studies have examined its association with neuropsychiatric symptoms (NPS). We examined this topic in a population-based sample of persons with dementia. DESIGN Longitudinal, observational cohort study. SETTING Community. PARTICIPANTS Two hundred ninety-two persons with dementia (71.9% Alzheimer's disease, 56.2% women) were followed up to 6 years. MEASUREMENTS We used a modified Mini-Nutritional Assessment (mMNA) and the Neuropsychiatric Inventory (NPI) to evaluate nutritional status and NPS, respectively. Individual linear mixed effects models examined the associations between time-varying mMNA total score or clinical categories (malnourishment, risk for malnourishment, or well-nourished) and NPI total score (excluding appetite domain) or NPI individual domain or cluster (e.g. psychosis) scores. Covariates tested were dementia onset age, type, and duration, medical comorbidities, sex, apolipoprotein E (APOE) genotype, and education. RESULTS Compared to the well-nourished, those at risk for malnourishment and those malnourished had higher total NPI scores [b (95% CI) = 1.76 (0.04, 3.48) or 3.20 (0.62, 5.78), respectively], controlling for significant covariates. Higher mMNA total score (better nutritional status) was associated with lower total NPI [b (95% CI) = -0.58 (-0.86, -0.29)] and lower domain scores for psychosis [b (95% CI) = -0.08 (-0.16, .004)], depression [b (95% CI = -0.11 (-0.16, -0.05], and apathy [b (95% CI = -0.19 (-0.28, -0.11)]. CONCLUSIONS Worse nutritional status is associated with more severe NPS. Dietary or behavioral interventions to prevent malnutrition may be beneficial for persons with dementia.
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Affiliation(s)
- Kaitlyn Kauzor
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Mikaela Drewel
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Hector Gonzalez
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Gail B Rattinger
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, P.O. Box 6000. Binghamton, NY 13902-6000, USA
| | - Alexandra G Hammond
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
| | - Heidi Wengreen
- Nutrition Dietetics and Food Sciences, Utah State University, 8710 Old Main Hill, Logan, UT 84322-8710, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Drive, 4th Floor, Baltimore, MD 21224, USA
| | - JoAnn T Tschanz
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
- Alzheimer's Disease and Dementia Research Center, Utah State University, 6405 Old Main Hill, Logan, UT, 84322-6405, USA
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17
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Murphy K, Khan A, Bachu A, Tampi R. Treatment of behavioral and psychological symptoms of dementia using transcranial magnetic stimulation: a systematic review. Int Psychogeriatr 2023; 35:611-622. [PMID: 36803624 DOI: 10.1017/s1041610223000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Behavioral and psychological symptoms of dementia (BPSD) are a group of noncognitive symptoms that occur commonly among individuals with dementia. These symptoms worsen the morbidity and mortality among individuals with dementia and significantly increase the cost of caring for these individuals. Transcranial magnetic stimulation (TMS) has been shown to have some benefits in the treatment of BPSD. This review provides an updated summary of the effect of TMS on BPSD. METHODS We conducted a systematic review of PubMed, Cochrane, and Ovid databases on the use of TMS to treat BPSD. RESULTS We found 11 randomized controlled studies that evaluated the use of TMS among individuals with BPSD. Three of these studies examined the effect of TMS on apathy, two of which showed significant benefit. Seven studies showed that TMS significantly improves BPSD: six using repetitive transcranial magnetic stimulation (rTMS) and one using transcranial direct current stimulation (tDCS). Four studies, two evaluating tDCS, one evaluating rTMS, and one evaluating intermittent theta-burst stimulation (iTBS) showed a nonsignificant impact of TMS on BPSD. Adverse events were predominantly mild and transitory in all studies. CONCLUSION Available data from this review indicate that rTMS is beneficial for individuals with BPSD, especially among individuals with apathy, and is well tolerated. However, more data are needed to prove the efficacy of tDCS and iTBS. Additionally, more randomized controlled trials with longer treatment follow-up and standardized use of BPSD assessments are needed to determine the best dose, duration, and modality for effective treatment of BPSD.
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Affiliation(s)
- Kayla Murphy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amber Khan
- Montefiore Medical Center, Bronx, NY, USA
| | - Anil Bachu
- Department of Psychiatry, Baptist Health-UAMS, North Little Rock, AR, USA
| | - Rajesh Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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18
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Seritan AL. Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review. J Geriatr Psychiatry Neurol 2023; 36:435-460. [PMID: 36941085 PMCID: PMC10578041 DOI: 10.1177/08919887231164357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background: Approximately 15% of older adults may experience psychotic phenomena. Primary psychiatric disorders that manifest with psychosis (delusions, hallucinations, and disorganized thought or behavior) account for less than half. Up to 60% of late-life psychotic symptoms are due to systemic medical or neurological conditions, particularly neurodegenerative diseases. A thorough medical workup including laboratory tests, additional procedures if indicated, and neuroimaging studies is recommended. This narrative review summarizes current evidence regarding the epidemiology and phenomenology of psychotic symptoms encountered as part of the neurodegenerative disease continuum (including prodromal and manifest stages). Results: Prodromes are constellations of symptoms that precede the onset of overt neurodegenerative syndromes. Prodromal psychotic features, particularly delusions, have been associated with an increased likelihood of receiving a neurodegenerative disease diagnosis within several years. Prompt prodrome recognition is crucial for early intervention. The management of psychosis associated with neurodegenerative diseases includes behavioral and somatic strategies, although evidence is scarce and mostly limited to case reports, case series, or expert consensus guidelines, with few randomized controlled trials. Conclusion: The complexity of psychotic manifestations warrants management by interprofessional teams that provide coordinated, integrated care.
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Affiliation(s)
- Andreea L. Seritan
- University of California, San Francisco Department of Psychiatry and UCSF Weill Institute for Neurosciences, CA, USA
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19
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Grycuk E, Eichenholtz E, Aarsland D, Betzhold S, Daly G, Fitzpatrick R, Folkerts AK, Kalbe E, Kane JPM, Kinchin I, Saldanha IJ, Smith V, Taylor JP, Thompson R, Leroi I. Developing a core outcome set (COS) for Dementia with Lewy bodies (DLB). HRB Open Res 2023; 5:57. [PMID: 36619176 PMCID: PMC9772580 DOI: 10.12688/hrbopenres.13590.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 10/13/2023] Open
Abstract
Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with a range of clinical manifestations, including motor, neuropsychiatric, and autonomic symptoms. Compared with more common forms of dementia such as Alzheimer's disease, DLB has been the focus of significantly fewer treatment studies, often with diverse outcome measures, making comparison and clinical implementation difficult. A core outcome set (COS) can address this by ensuring that data are comparable, relevant, useful, and usable for making the best healthcare decisions. Methods: Using a multi-stage approach, development of the DLB-COS will include the following stages: (1) A systematic review, following PRISMA guidelines to create an initial long list of outcomes; (2) A two-round online Delphi including clinicians, scientists, policymakers, and individuals with lived experience of DLB and their representatives; (3) An online consensus meeting to agree on the final core list of outcomes (the final DLB-COS) for use in research and clinical practice; (4) A systematic review to identify appropriate measurement instruments for the DLB-COS outcomes; (5) A final consensus meeting of the professional stakeholders who attended the online consensus meeting to agree on the instruments that should be used to measure the outcomes in the DLB-COS; and (6) Global dissemination. Discussion: This is a multi-stage project to develop a COS to be used in treatment trials for DLB. A DLB-COS will ensure the selection of relevant outcomes and will identify the instruments to be used to measure DLB globally. Keywords: Dementia, Dementia with Lewy Bodies, Core Outcome Set, Delphi, Systematic Review, Ageing, Cognition, Memory.
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Affiliation(s)
- Emilia Grycuk
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Ireland
| | - Emily Eichenholtz
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | | | - Gillian Daly
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Rachel Fitzpatrick
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Joseph PM Kane
- Centre for Public Health, Queens University Belfast, Northern Ireland, UK
| | - Irina Kinchin
- Global Brain Health Institute, and Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | | | - Valerie Smith
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | - Iracema Leroi
- Global Brain Health Institute, and Department of Psychiatry, Trinity College Dublin, Ireland
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20
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Rhodus EK, Baum C, Kryscio R, Liu C, George R, Thompson M, Lowry K, Coy B, Barber J, Nichols H, Curtis A, Holloman A, Jicha GA. Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial. Am J Occup Ther 2023; 77:7704205010. [PMID: 37624998 PMCID: PMC10494967 DOI: 10.5014/ajot.2023.050124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Supporting community residency of adults with Alzheimer's disease (AD) is a critical public health initiative. Occupational therapy can contribute to this goal. OBJECTIVE To assess the feasibility of a novel telehealth intervention to support occupational engagement in community-residing people with AD. DESIGN Single-blind, three-arm, parallel, randomized controlled trial. SETTING Occupational therapy delivered through telehealth in participants' homes. PARTICIPANTS People with AD who reside in the community with behavioral symptoms and their care partners (dyads). INTERVENTIONS (1) HARMONY (Helping older Adults cReate & Manage OccupatioNs successfully), a telehealth intervention that applies principles of individualized guided discovery with environmental cueing for caregivers of persons with AD to promote activity participation and manage behavioral symptoms; (2) standardized training regarding the use of a sensory-based approach in dementia care; and (3) a control, including home safety education and weekly monitoring of behaviors. OUTCOMES AND MEASURES Feasibility was assessed as the primary outcome measured by completion of at least 75% of the telehealth sessions. Secondary outcomes included change in functional activity performance and neuropsychiatric behavioral symptoms. RESULTS Twenty-eight dyads participated. The intervention was feasible, with high adherence to weekly visits (M number of visits = 5.4 for HARMONY, 4.9 for standardized training, and 4.6 for control), with high participant retention in the intervention arms. HARMONY demonstrated promise in improving patient performance and behavioral symptoms. CONCLUSIONS AND RELEVANCE HARMONY is feasibly delivered through telehealth service and has a positive effect on occupational performance and behavioral symptoms of AD. Additional studies are needed to explore effectiveness in a broader population. What This Article Adds: Use of HARMONY for community-residing adults with AD is feasible and has promise for improving functional activity performance and behavioral symptoms, as well as caregiver satisfaction.
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Affiliation(s)
- Elizabeth K Rhodus
- Elizabeth K. Rhodus, PhD, OTR/L, is Assistant Professor, Sanders-Brown Center on Aging and Department of Behavioral Science, University of Kentucky, Lexington;
| | - Carolyn Baum
- Carolyn Baum, PhD, OTR/L, FAOTA, is Professor, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Richard Kryscio
- Richard Kryscio, PhD, is Professor, Sanders-Brown Center on Aging and Department of Statistics, University of Kentucky, Lexington
| | - Changrui Liu
- Changrui Liu, MS, is Graduate Assistant, Department of Statistics, University of Kentucky, Lexington
| | - Rosmy George
- Rosmy George, MS, BS, CCRP, is Clinical Trial Coordinator, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - MaryEllen Thompson
- MaryEllen Thompson, PhD, OTR/L, is Retired Professor, Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond
| | - Kimberly Lowry
- Kimberly Lowry, APRN, is Clinician, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Beth Coy
- Beth Coy, APRN, is Clinician, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Justin Barber
- Justin Barber, MS, CCRP, is Alzheimer's Disease Research Center & Affiliated Studies Team Leader, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Heather Nichols
- Heather Nichols, BS, CCRP, is Administrative Research Assistant Senior, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Alexandra Curtis
- Alexandra Curtis, MPH, CCRP, is Clinical Trials Research Manager, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Angela Holloman
- Angela Holloman, BS, is Program Manager Senior, Sanders-Brown Center on Aging, University of Kentucky, Lexington
| | - Gregory A Jicha
- Gregory A. Jicha, MD, PhD, is Professor, Sanders-Brown Center on Aging and Department of Neurology, University of Kentucky, Lexington
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21
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Meimandi M, Azad A, von Rosen P, Taghizadeh G. Consensus on Feedback Statements That Create Responsibility Among People With Parkinson's Disease: A Delphi Study. Am J Occup Ther 2023; 77:7704205160. [PMID: 37585597 DOI: 10.5014/ajot.2023.050231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
IMPORTANCE Sense of agency is associated with a sense of responsibility, which is essential to performing goal-directed occupations. OBJECTIVE To reach consensus on a set of extrinsic feedback statements that have the potential to create a sense of responsibility among patients with neurological disorders in the course of performing daily or social occupations. DESIGN Anonymous Delphi study with two rounds with international experts and one round with Irani patients with Parkinson's disease (PD). SETTING Electronic survey. PARTICIPANTS One hundred experts and 73 patients with idiopathic PD. OUTCOMES AND MEASURES Experts and patients anonymously rated (5 = strongly agree/very effective, 4 = agree/effective, 3 = neither agree nor disagree/uncertain, 2 = disagree/ineffective, 1 = strongly disagree/very ineffective) their level of agreement with each survey statement and the effectiveness of each statement in creating a sense of responsibility in the course of performing daily or social occupations. Consensus was set as an interquartile range of ≤1 and ≥70% agreement in two adjacent categories of a Likert scale. RESULTS In the experts' first round, consensus was reached on the level of agreement and effectiveness of 18 statements. In the second round, final consensus was achieved on all statements. In the one patient round, patients reached consensus on all statements. Finally, 34 statements were rated as 4 or 5 in terms of agreement and effectiveness, based on the opinions of experts and patients. CONCLUSIONS AND RELEVANCE This study has produced a collection of feedback statements that might be useful in occupation-based interventions. What This Article Adds: Extrinsic responsibility feedback delivered while administering occupation-based interventions may increase volition, motivation, and engagement.
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Affiliation(s)
- Mahsa Meimandi
- Mahsa Meimandi, MSc, is PhD Candidate, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Akram Azad, PhD, is Associate Professor, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Philip von Rosen
- Philip von Rosen, PhD, is Associate Professor, Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ghorban Taghizadeh
- Ghorban Taghizadeh, PhD, is Associate Professor, Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; or
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22
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Xu J, Hsu SH. Self-healing hydrogel as an injectable implant: translation in brain diseases. J Biomed Sci 2023; 30:43. [PMID: 37340481 DOI: 10.1186/s12929-023-00939-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023] Open
Abstract
Tissue engineering biomaterials are aimed to mimic natural tissue and promote new tissue formation for the treatment of impaired or diseased tissues. Highly porous biomaterial scaffolds are often used to carry cells or drugs to regenerate tissue-like structures. Meanwhile, self-healing hydrogel as a category of smart soft hydrogel with the ability to automatically repair its own structure after damage has been developed for various applications through designs of dynamic crosslinking networks. Due to flexibility, biocompatibility, and ease of functionalization, self-healing hydrogel has great potential in regenerative medicine, especially in restoring the structure and function of impaired neural tissue. Recent researchers have developed self-healing hydrogel as drug/cell carriers or tissue support matrices for targeted injection via minimally invasive surgery, which has become a promising strategy in treating brain diseases. In this review, the development history of self-healing hydrogel for biomedical applications and the design strategies according to different crosslinking (gel formation) mechanisms are summarized. The current therapeutic progress of self-healing hydrogels for brain diseases is described as well, with an emphasis on the potential therapeutic applications validated by in vivo experiments. The most recent aspect as well as the design rationale of self-healing hydrogel for different brain diseases is also addressed.
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Affiliation(s)
- Junpeng Xu
- Institute of Polymer Science and Engineering, National Taiwan University, No. 1, Sec. 4 Roosevelt Road, Taipei, 106319, Taiwan, Republic of China
| | - Shan-Hui Hsu
- Institute of Polymer Science and Engineering, National Taiwan University, No. 1, Sec. 4 Roosevelt Road, Taipei, 106319, Taiwan, Republic of China.
- Institute of Cellular and System Medicine, National Health Research Institutes, No. 35 Keyan Road, Miaoli, 350401, Taiwan, Republic of China.
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23
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Cahan JG, Vassar R, Bonakdarpour B. Lower Cerebrospinal Fluid Amyloid-β 42 Predicts Sooner Time to Antipsychotic Use in Alzheimer's Disease. J Alzheimers Dis Rep 2023; 7:641-647. [PMID: 37483323 PMCID: PMC10357113 DOI: 10.3233/adr-220064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Cerebrospinal fluid (CSF) biomarkers of amyloid-β42 (Aβ42) and phosphorylated-tau help clinicians accurately diagnose Alzheimer's disease (AD). Whether biomarkers help prognosticate behavioral and psychological symptoms of dementia (BPSD) is unclear. Objective Determine whether CSF biomarker levels aid prognostication of BPSD in AD. Methods This retrospective cohort study included patients over 65 with a diagnosis of AD based on CSF biomarkers. We measured time from CSF testing to the first antipsychotic use in the following months. We then analyzed time to antipsychotic (AP) use with respect to Aβ42, total tau, phosphorylated tau, and amyloid-to-tau index using a survival analysis approach. Results Of 86 AD patients (average 72±5 years, 46.5% male), 11 patients (12.7%) received APs following CSF testing. Patients with Aβ42 below the median had sooner time-to-AP use. This was significant on a log-rank test (p = 0.04). There was no difference in time-to-AP use if the group was stratified by levels of total tau, phosphorylated tau, or amyloid-to-tau index. Conclusion These results suggest a relationship between lower CSF Aβ42 levels and sooner AP use. This supports prior reports suggesting a correlation between BPSD and Aβ deposition on PET. These results highlight the need for further prospective studies on Aβ levels and BPSD.
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Affiliation(s)
- Joshua G. Cahan
- Mesulam Center for Cognitive Neurology and Alzheimer Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert Vassar
- Mesulam Center for Cognitive Neurology and Alzheimer Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Borna Bonakdarpour
- Mesulam Center for Cognitive Neurology and Alzheimer Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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24
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Du H, Bo L, Lai X, Zhu H, Huo X. Network meta-analysis of comparative efficacy of animal-assisted therapy vs. pet-robot therapy in the management of dementia. Front Aging Neurosci 2023; 15:1095996. [PMID: 37323139 PMCID: PMC10264590 DOI: 10.3389/fnagi.2023.1095996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/21/2023] [Indexed: 06/17/2023] Open
Abstract
Objective This network meta-analysis aimed to compare and rank the efficacy of animal-assisted therapy (AAT) and pet-robotic therapy (PRT) in the management of dementia. Methods Relevant studies were identified by searching PubMed, EMBASE, the Cochrane Library, SCOPUS, and Web of Science (WoS) until October 13, 2022. Traditional meta-analysis was first conducted based on the random-effects model, then random network meta-analysis was conducted to determine the relative efficacy and rank probability of AAT and PRT. Results Nineteen randomized controlled trials (RCTs) were included in this network meta-analysis. Network meta-analysis revealed that PRT marginally benefited agitation alleviation compared with control (standard mean difference [SMD]: -0.37, 95% confidence interval [95%CI]: -0.72 to -0.01) although both AAT and PRT did not improve cognitive function, reduce depression, and improve Quality of Life (QoL). The SUCRA probabilities indicated that PRT ranked better than AAT in agitation, cognitive function, and QoL, although there were no differences between the two therapies. Conclusion The present network meta-analysis reveals that PRT may help alleviate agitated behaviors in people with dementia. However, future studies are warranted to establish evidence of the effectiveness of PRT and further evaluate the differences between different robot types in managing dementia.
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Affiliation(s)
- Hongdi Du
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Bo
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxing Lai
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongwei Zhu
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaopeng Huo
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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25
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Eikelboom WS, van den Berg E, Coesmans M, Goudzwaard JA, Koopmanschap M, Lazaar N, van Bruchem-Visser RL, Driesen JJM, den Heijer T, Hoogers S, de Jong FJ, Mattace-Raso F, Thomeer EC, Vrenken S, Vroegindeweij LJHM, Zuidema SU, Singleton EH, van Swieten JC, Ossenkoppele R, Papma JM. Effects of the DICE Method to Improve Timely Recognition and Treatment of Neuropsychiatric Symptoms in Early Alzheimer's Disease at the Memory Clinic: The BEAT-IT Study. J Alzheimers Dis 2023:JAD230116. [PMID: 37182887 DOI: 10.3233/jad-230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are highly prevalent in Alzheimer's disease (AD) and are associated with negative outcomes. However, NPS are currently underrecognized at the memory clinic and non-pharmacological interventions are scarcely implemented. OBJECTIVE To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic. METHODS We enrolled sixty community-dwelling people with mild cognitive impairment or AD dementia and NPS across six Dutch memory clinics with their caregivers. The first wave underwent care as usual (n = 36) and the second wave underwent the DICE method (n = 24). Outcomes were quality of life (QoL), caregiver burden, NPS severity, NPS-related distress, competence managing NPS, and psychotropic drug use. Reliable change index was calculated to identify responders to the intervention. A cost-effectiveness analysis was performed and semi-structured interviews with a subsample of the intervention group (n = 12). RESULTS The DICE method did not improve any outcomes over time compared to care as usual. Half of the participants of the intervention group (52%) were identified as responders and showed more NPS and NPS-related distress at baseline compared to non-responders. Interviews revealed substantial heterogeneity among participants regarding NPS-related distress, caregiver burden, and availability of social support. The intervention did not lead to significant gains in quality-adjusted life years and well-being years nor clear savings in health care and societal costs. CONCLUSION The DICE method showed no benefits at group-level, but individuals with high levels of NPS and NPS-related distress may benefit from this intervention.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Najoua Lazaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Jan J M Driesen
- Department of Neurology, Franciscus Vlietland, Schiedam, The Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Susanne Hoogers
- Department of Neurology, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Elsbeth C Thomeer
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne Vrenken
- Department of Geriatrics, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | | | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen H Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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26
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Taléns-Visconti R, de Julián-Ortiz JV, Vila-Busó O, Diez-Sales O, Nácher A. Intranasal Drug Administration in Alzheimer-Type Dementia: Towards Clinical Applications. Pharmaceutics 2023; 15:pharmaceutics15051399. [PMID: 37242641 DOI: 10.3390/pharmaceutics15051399] [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: 04/03/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Alzheimer-type dementia (ATD) treatments face limitations in crossing the blood-brain barrier and systemic adverse effects. Intranasal administration offers a direct route to the brain via the nasal cavity's olfactory and trigeminal pathways. However, nasal physiology can hinder drug absorption and limit bioavailability. Therefore, the physicochemical characteristics of formulations must be optimized by means of technological strategies. Among the strategies that have been explored, lipid-based nanosystems, particularly nanostructured lipid carriers, are promising in preclinical investigations with minimal toxicity and therapeutic efficacy due to their ability to overcome challenges associated with other nanocarriers. We review the studies of nanostructured lipid carriers for intranasal administration in the treatment of ATD. Currently, no drugs for intranasal administration in ATD have marketing approval, with only three candidates, insulin, rivastigmine and APH-1105, being clinically investigated. Further studies with different candidates will eventually confirm the potential of the intranasal route of administration in the treatment of ATD.
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Affiliation(s)
- Raquel Taléns-Visconti
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Av. Vicent Andrés Estellés s/n, 46100 Valencia, Spain
| | - Jesus Vicente de Julián-Ortiz
- Molecular Topology and Drug Design Research Unit, Department of Physical Chemistry, Faculty of Pharmacy, University of Valencia, Av. Vicent Andrés Estellés s/n, 46100 Valencia, Spain
| | - Ofelia Vila-Busó
- Colloids Research Unit, Department of Physical Chemistry, Faculty of Pharmacy, University of Valencia, Av. Vicent Andrés Estellés s/n, 46100 Valencia, Spain
| | - Octavio Diez-Sales
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Av. Vicent Andrés Estellés s/n, 46100 Valencia, Spain
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Av. Vicent Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain
| | - Amparo Nácher
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Av. Vicent Andrés Estellés s/n, 46100 Valencia, Spain
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Av. Vicent Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain
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27
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Mahmoudi R, Novella JL, Laurent-Badr S, Boulahrouz S, Tran D, Morrone I, Jaïdi Y. Cholinergic Antagonists and Behavioral Disturbances in Neurodegenerative Diseases. Int J Mol Sci 2023; 24:ijms24086921. [PMID: 37108085 PMCID: PMC10138684 DOI: 10.3390/ijms24086921] [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: 02/14/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Cholinergic antagonists interfere with synaptic transmission in the central nervous system and are involved in pathological processes in patients with neurocognitive disorders (NCD), such as behavioral and psychological symptoms of dementia (BPSD). In this commentary, we will briefly review the current knowledge on the impact of cholinergic burden on BPSD in persons with NCD, including the main pathophysiological mechanisms. Given the lack of clear consensus regarding symptomatic management of BPSD, special attention must be paid to this preventable, iatrogenic condition in patients with NCD, and de-prescription of cholinergic antagonists should be considered in patients with BPSD.
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Affiliation(s)
- Rachid Mahmoudi
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
- UR 3797 Vieillissement, Fragilité (VieFra), Faculty of Medicine, University of Reims Champagne-Ardenne, 51687 Reims, France
| | - Jean Luc Novella
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
- UR 3797 Vieillissement, Fragilité (VieFra), Faculty of Medicine, University of Reims Champagne-Ardenne, 51687 Reims, France
| | - Sarah Laurent-Badr
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
| | - Sarah Boulahrouz
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
- UR 3797 Vieillissement, Fragilité (VieFra), Faculty of Medicine, University of Reims Champagne-Ardenne, 51687 Reims, France
| | - David Tran
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
| | - Isabella Morrone
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
- Cognition Health and Society Laboratory (C2S-EA 6291), Faculty of Medicine, University of Reims Champagne-Ardenne, 51687 Reims, France
| | - Yacine Jaïdi
- Department of Geriatric and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 51092 Reims, France
- UR 3797 Vieillissement, Fragilité (VieFra), Faculty of Medicine, University of Reims Champagne-Ardenne, 51687 Reims, France
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28
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Lee D, Clark ED, Antonsdottir IM, Porsteinsson AP. A 2023 update on the advancements in the treatment of agitation in Alzheimer's disease. Expert Opin Pharmacother 2023; 24:691-703. [PMID: 36958727 DOI: 10.1080/14656566.2023.2195539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) in Alzheimer's Disease (AD) are associated with negative outcomes for patients and their care partners. Agitation is one of the most common and distressing NPS, yet we lack safe and effective treatment options. While nonpharmacologic interventions are considered first line treatment, these may not be effective or appropriate for every patient. Our current approaches to the pharmacologic treatment of agitation in AD consist of the off-label use of antipsychotics, sedative/hypnotics, anxiolytics, mood-stabilizing anticonvulsants, acetylcholinesterase inhibitors, NMDA receptor antagonists, and antidepressants. Despite their prevalent use, they have questionable efficacy and significant safety concerns. AREAS COVERED Advances in the understanding of neurobiological mechanisms of agitation have fueled recent clinical trials. This article is an update to our 2017 review. A comprehensive search of ClinicalTrials.gov was completed from January 2017 to June 2022 using the search terms "Alzheimer's Disease" and "Agitation". A subsequent scoping review was completed in PubMed and Google Scholar. Several agents were identified for promise in treating agitation, including: brexpiprazole, cannabinoids, dexmedetomidine, dextromethorphan, escitalopram, masupirdine, and prazosin. EXPERT OPINION Clinical trials remain underway utilizing both novel and repurposed agents to address symptoms of agitation in AD. With increasing understanding of the neurobiological mechanisms that fuel the development of agitation in AD, the use of enhanced trial design and conduct, advanced statistical approaches, and accelerated pathways for regulatory approval, we are advancing closer to having safe and efficacious treatment options for agitation in AD.
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Affiliation(s)
- Daniel Lee
- Alzheimer's Disease Care, Research and Education (AD-CARE), Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642
| | - Emily D Clark
- Alzheimer's Disease Care, Research and Education (AD-CARE), Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642
| | - Inga M Antonsdottir
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, 21205, Baltimore, MD, USA
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Anton P Porsteinsson
- Alzheimer's Disease Care, Research and Education (AD-CARE), Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642
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29
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Loi SM, Cations M, Velakoulis D. Young-onset dementia diagnosis, management and care: a narrative review. Med J Aust 2023; 218:182-189. [PMID: 36807325 PMCID: PMC10952480 DOI: 10.5694/mja2.51849] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
Young-onset dementia comprises a heterogeneous range of dementias, with onset at less than 65 years of age. These include primary dementias such as Alzheimer disease, frontotemporal and vascular dementias; genetic/familial dementias; metabolic disorders; and secondary dementias such as those that result from alcohol use disorder, traumatic brain injury, and infections. The presentation of young-onset dementia is varied and may include cognitive, psychiatric and neurological symptoms. Diagnostic delay is common, with a frequent diagnostic conundrum being, "Is this young-onset dementia or is this psychiatric?". For assessment and accurate diagnosis, a thorough screen is recommended, such as collateral history and investigations such as neuroimaging, lumbar puncture, neuropsychology, and genetic testing. The management of young-onset dementia needs to be age-appropriate and multidisciplinary, with timely access to services and consideration of the family (including children).
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Affiliation(s)
- Samantha M Loi
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
| | | | - Dennis Velakoulis
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
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30
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Chirico I, Pappadà A, Giebel C, Ottoboni G, Valente M, Gabbay M, Chattat R. The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy. Aging Ment Health 2023; 27:512-520. [PMID: 35333142 DOI: 10.1080/13607863.2022.2056137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The COVID-19 pandemic and public health measures caused serious consequences for several population cohorts, including people with dementia in care homes and their families. The aim of this study was to explore the impact of COVID-19 on care home residents with dementia as experienced by family carers in Italy. Specifically, strategies implemented to overcome the pandemic's constraints, their influence upon care, and consequences for everyday life of residents with dementia and carers were investigated. METHODS Semi-structured interviews explored participants' experiences of the pandemic, its restrictions and the services' status during lockdown. Transcripts were analysed via thematic analysis. RESULTS 26 family carers were interviewed. Three themes emerged: (1) COVID-19 restrictions negatively affected both residents with dementia and family carers, (2) Changing policies in care homes during COVID-19, and (3) Technology use in care homes during COVID-19. COVID-19 restrictions severely affected care home residents with dementia, disrupted their daily living, and accelerated their cognitive decline. Consequently carers' emotional burdens increased. Care home response strategies (safe visiting and digital solutions) were critical, though they were not enough to compensate for the lack of close in-person contacts. CONCLUSIONS Mixed evidence emerged about the feasibility of care home strategies and their associated benefits. To meet arising needs and possible future pandemic waves, there is a need for updated health strategies. These should prioritise a continuity of therapeutic activities and minimize negative effects on residents' quality of life, whilst incorporating feasible and accessible digital solutions to provide remote communication and psychological support for family carers.
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Affiliation(s)
| | | | - Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | | | - Marco Valente
- Department of Psychology, University of Bologna, Italy
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Italy
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31
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Shehata MK, Ismail AA, Kamel MA. Nose to Brain Delivery of Astaxanthin–Loaded Nanostructured Lipid Carriers in Rat Model of Alzheimer’s Disease: Preparation, in vitro and in vivo Evaluation. Int J Nanomedicine 2023; 18:1631-1658. [PMID: 37020692 PMCID: PMC10069509 DOI: 10.2147/ijn.s402447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Background Astaxanthin (AST) is a second-generation antioxidant with anti-inflammatory and neuroprotective properties and could be a promising candidate for Alzheimer's disease (AD) therapy, but is shows poor oral bioavailability due to its high lipophilicity. Purpose This study aimed to prepare and evaluate AST-loaded nanostructured lipid carriers (NLCs), for enhanced nose-to-brain drug delivery to improve its therapeutic efficacy in rat model of AD. Methods AST-NLCs were prepared using hot high-pressure homogenization technique, and processing parameters such as total lipid-to-drug ratio, solid lipid-to-liquid lipid ratio, and concentration of surfactant were optimized. Results The optimized AST-NLCs had a mean particle size of 142.8 ± 5.02 nm, polydispersity index of 0.247 ± 0.016, zeta potential of -32.2 ± 7.88 mV, entrapment efficiency of 94.1 ± 2.46%, drug loading of 23.5 ± 1.48%, and spherical morphology as revealed by transmission electron microscopy. Differential scanning calorimetry showed that AST was molecularly dispersed in the NLC matrix in an amorphous state, whereas Fourier transform infrared spectroscopy indicated that there is no interaction between AST and lipids. AST displayed a biphasic release pattern from NLCs; an initial burst release followed by sustained release for 24 h. AST-NLCs were stable at 4-8 ±2°C for six months. Intranasal treatment of AD-like rats with the optimized AST-NLCs significantly decreased oxidative stress, amyloidogenic pathway, neuroinflammation and apoptosis, and significantly improved the cholinergic neurotransmission compared to AST-solution. This was observed by the significant decline in the levels of malondialdehyde, nuclear factor-kappa B, amyloid beta (Aβ1‑42), caspase-3, acetylcholinesterase, and β-site amyloid precursor protein cleaving enzyme-1 expression, and significant increase in the contents of acetylcholine and glutathione after treatment with AST-NLCs. Conclusion NLCs enhanced the intranasal delivery of AST and significantly improved its therapeutic properties.
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Affiliation(s)
- Mustafa K Shehata
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Correspondence: Mustafa K Shehata, Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Khartoum Square, Azzarita, Alexandria, 21521, Egypt, Tel +20 1114740302, Fax +20 3 4871668, Email ;
| | - Assem A Ismail
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Maher A Kamel
- Department of Biochemistry, Medical Research Institute, Alexandria University, Alexandria, Egypt
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32
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Ardelean A, Redolat R. Supporting Behavioral and Psychological Challenges in Alzheimer Using Technology: A Systematic Review. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2172900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- A. Ardelean
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
| | - R. Redolat
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
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Eikelboom WS, Koch J, Beattie E, Lautenschlager NT, Doyle C, van den Berg E, Papma JM, Anstey KJ, Mortby ME. Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records. Aging Ment Health 2023; 27:243-250. [PMID: 35100918 DOI: 10.1080/13607863.2022.2032597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. METHODS We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67-101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. RESULTS 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident's needs, removing identified triggers, or distracting. CONCLUSION Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597 .
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Affiliation(s)
- Willem S Eikelboom
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jana Koch
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Colleen Doyle
- National Aging Research Institute, Parkville, VIC, Australia
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Moyra E Mortby
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
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Kurhan F, Akın M. A New Hope in Alzheimer's Disease Psychosis: Pimavanserin. Curr Alzheimer Res 2023; 20:403-408. [PMID: 37641988 DOI: 10.2174/1567205020666230825124922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/04/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023]
Abstract
Alzheimer's disease (AD) ranks first among the causes of dementia worldwide. AD can develop a psychotic manifest at a significant rate. AD prognosis worsens by added psychosis clinic. There is no treatment approved by the United States Food and Drug Administration (FDA) among antipsychotics for Alzheimer's disease Psychosis (ADP). However, pimavanserine, an atypical antipsychotic, has been approved by the FDA for Parkinson's psychosis. It is predicted that pimavanserin, a new antipsychotic, will fill an important gap in this area. In clinical trials, it appears to be effective in the treatment of delusions and hallucinations at psychosis in both Parkinson's and AD. In this systematic review, we evaluated the analysis of current literature data on pimavanserin used in ADP. We searched the existing literature on clinical studies on pimavanserin therapy used in ADP. Data were determined by systematically searching PubMed, MEDLINE, EMBASE, and Google Scholar until December 2022. A total of 35 citations were found and uploaded on the Mendeley program. Abstracts and full texts of literature data were examined. Pimavanserin was observed, and satisfactory results were obtained in treating ADP. Pimavanserin has a unique mechanism of action. Pimavanserin, an atypical antipsychotic drug, has a low affinity for 5-HT2C receptors and has selective 5-HT2A reverse agonist/antagonist action. Pimavanserin has no clinically significant affinity for dopaminergic, histaminergic, muscarinic or adrenergic receptors. This agent may also achieve significant positive results in resistant psychosis treatments.
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Affiliation(s)
- Faruk Kurhan
- Department of Psychiatry, Faculty of Medicine, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Mustafa Akın
- Department of Psychiatry, Faculty of Medicine, Van Yuzuncu Yil University, 65100, Van, Turkey
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35
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Kłosińska U, Leszko M. CBD Oil as a Miracle Drug: A Thematic Analysis of Caregivers’ Attitudes and Practices Towards Cannabidiol in Dementia Treatment. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221145019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this study was to understand caregivers of individuals with dementia attitudes toward CBD oil. Thematic analysis was conducted with 67 posts (570 comments) about CBD oil selected from a Polish online support forum for caregivers. We identified caregivers’ expectations, motivations, and practices of using CBD oil. Caregivers expected CBD to improve the behavior, cognition, communication, and daily activities of their loved ones. They motivated each other by sharing experiences about the positive effects of CBD oil and claimed to be administering CBD oil without medical advice, which led to dangerous practices such as an overnight withdrawal of all drugs or experimenting with CBD oil dosage. Caregivers perceive CBD oil as a safer and more effective treatment for those with dementia than the conventional methods. We recommend healthcare professionals inquire about possible CBD oil usage during follow-up visits and thoroughly explain what to expect from prescribed medications.
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Affiliation(s)
- Urszula Kłosińska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - Magdalena Leszko
- Department of Psychology, University of Szczecin, Szczecin, Poland
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Tampi RR, Tampi DJ, Farheen SA, Ochije SI, Joshi P. Propranolol for the management of behavioural and psychological symptoms of dementia. Drugs Context 2022; 11:dic-2022-8-3. [PMID: 36544625 PMCID: PMC9753600 DOI: 10.7573/dic.2022-8-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
Propranolol is a β-adrenergic antagonist used in the management of hypertension, cardiac arrhythmia, and angina pectoris. There is some evidence that propranolol may benefit individuals with behavioural and psychological symptoms of dementia (BPSD). A total of three case series, one randomized controlled trial and one case report were identified (from a literature search of three major databases: PubMed, Ovid, and Cochrane collaboration) that assessed the use of propranolol for the management of BPSD. From these studies, it appears that propranolol improves BPSD, including agitation and aggression. Propranolol is also well tolerated with no significant bradycardia or hypotension noted in these studies. Current data on the use of propranolol for the management of BPSD are limited in comparison to other pharmacological agents (atypical antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, and cannabinoids) and treatment modalities (repetitive transcranial magnetic stimulation and electroconvulsive therapy). The efficacy and safety of these treatments among individuals with BPSD has been evaluated in multiple controlled studies. In clinical practice, the routine use of propranolol among people with BPSD cannot be recommended at this time given the limited data. However, propranolol can be trialled among individuals with BPSD when symptoms have not responded adequately to other medications. Propranolol may also be used prior to embarking on trials of repetitive transcranial magnetic stimulation and electroconvulsive therapy among people with BPSD given the greater acceptance of this medication in the general population.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA
| | - Deena J Tampi
- Co-Founder and Managing Principal, Behavioral Health Advisory Group, Princeton, NJ, USA
| | - Syeda Arshiya Farheen
- Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA
| | - Sochima I Ochije
- Department of Psychiatry, Emory University Hospital, Atlanta GA, USA
| | - Pallavi Joshi
- Department of Psychiatry, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Hill JE, Gomez KU, Harrison J. Dementia and the risk of poor outcomes as a result of the COVID-19 pandemic. BRITISH JOURNAL OF NEUROSCIENCE NURSING 2022; 18:226-228. [PMID: 38800135 PMCID: PMC7615974 DOI: 10.12968/bjnn.2022.18.5.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
People with dementia belong to some of the most vulnerable groups and their vulnerability has been augmented by the Covid-19 pandemic. This article provides a critical appraisal and evaluation of a systematic review that has investigated the relationship between dementia and COVID-19 related outcomes.
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Affiliation(s)
| | | | - Joanna Harrison
- Synthesis, Economic Evaluation and Decision Science Group, University of Central Lancashire
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38
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Brucki SMD, Aprahamian I, Borelli WV, Silveira VCD, Ferretti CEDL, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Nitrini R, Schultz RR, Morillo LS. Management in severe dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s107en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Alzheimer’s disease (AD) and other neurodegenerative dementias have a progressive course, impairing cognition, functional capacity, and behavior. Most studies have focused on AD. Severe dementia is associated with increased age, higher morbidity-mortality, and rising costs of care. It is fundamental to recognize that severe dementia is the longest period of progression, with patients living for many years in this stage. It is the most heterogeneous phase in the process, with different abilities and life expectancies. This practice guideline focuses on severe dementia to improve management and care in this stage of dementia. As it is a long period in the continuum of dementia, clinical practice should consider non-pharmacological and pharmacological approaches. Multidisciplinary interventions (physical therapy, speech therapy, nutrition, nursing, and others) are essential, besides educational and support to caregivers.
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Affiliation(s)
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Brasil; University of Groningen, The Netherlands; Universidade de São Paulo, Brasil
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brazil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Soofi H. Respect for Autonomy and Dementia Care in Nursing Homes: Revising Beauchamp and Childress's Account of Autonomous Decision-Making. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:467-479. [PMID: 35749025 PMCID: PMC9463234 DOI: 10.1007/s11673-022-10195-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/14/2022] [Indexed: 05/26/2023]
Abstract
Specifying the moral demands of respect for the autonomy of people with dementia (PWD) in nursing homes (NHs) remains a challenging conceptual task. These challenges arise primarily because received notions of autonomous decision-making and informed consent do not straightforwardly apply to PWD in NHs. In this paper, I investigate whether, and to what extent, the influential account of autonomous decision-making and informed consent proposed by Beauchamp and Childress has applicability and relevance to PWD in NHs. Despite its otherwise practical orientation and suitability for acute care settings, I identify three problems with this account when applied to PWD in NHs. These problems include (1) intentionality as an all-or-nothing condition of autonomous decision-making, (2) construing consent as one-off authorization, and (3) unresolved ambiguities around the primacy of precedent autonomy over best interest considerations. To address these problems, I propose and defend a number of revisions to Beauchamp and Childress's account. First, I suggest that we consider intentionality as a non-binary criterion of autonomous decision-making. Second, I argue for a model of process consent to overcome the moral inadequacy of construing consent as one-off authorization in NHs. And, to overcome the third problem, I suggest accounting for both precedent and extant autonomy of PWD, considering mandates of precedent autonomy not as prescriptive but as informative, and drawing a less rigid distinction between autonomy considerations and best interest judgements. I conclude that this revised version of Beauchamp and Childress's account fares better than the original version in capturing relevant autonomy considerations to care for PWD in NHs.
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Affiliation(s)
- Hojjat Soofi
- Department of Clinical Medicine, Macquarie University, Level 1, 75 Talavera Rd, Macquarie Park, NSW, 2113, Australia.
- Department of Philosophy, Macquarie Univesity, Levels 6, 25B Wally's Walk, Macquarie Park, NSW, 2109, Australia.
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40
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NAbiximols Clinical Translation To the treatment of Pain and Agitation In Severe Dementia (NACTOPAISD): Clinical trial protocol. Biomed Pharmacother 2022; 153:113488. [DOI: 10.1016/j.biopha.2022.113488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
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41
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Polypharmacy in Treatment of Behavioral Issues in Dementia—Use of Atypical Antipsychotics. Clin Geriatr Med 2022; 38:641-652. [DOI: 10.1016/j.cger.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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42
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Brucki SMD, Aprahamian I, Borelli WV, Silveira VCD, Ferretti CEDL, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Nitrini R, Schultz RR, Morillo LS. Manejo das demências em fase avançada: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:101-120. [DOI: 10.1590/1980-5764-dn-2022-s107pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/04/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
RESUMO A doença de Alzheimer (DA) e outras demências neurodegenerativas têm um curso progressivo com comprometimento da cognição, capacidade funcional e comportamento. A maioria dos estudos enfocou a DA. A demência grave está associada ao aumento da idade, maior morbimortalidade e aumento dos custos de cuidados. É fundamental reconhecer que a demência grave é o período mais longo de progressão, com o paciente vivendo muitos anos nesta fase. É a fase mais heterogênea do processo, com diferentes habilidades e expectativa de vida. Esta diretriz de prática concentra-se na demência grave para melhorar o manejo e o cuidado nessa fase da demência. Como um longo período no continuum da demência, as abordagens não farmacológicas e farmacológicas devem ser consideradas. Intervenções multidisciplinares (fisioterapia, fonoaudiologia, nutrição, enfermagem, entre outras) são essenciais, além de educacionais e de apoio aos cuidadores.
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Affiliation(s)
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Brasil; University of Groningen, The Netherlands; Universidade de São Paulo, Brasil
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brazil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Caramelli P, Marinho V, Laks J, Coletta MVD, Stella F, Camargos EF, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Chaves MLF, Brucki SMD, Nitrini R, Durgante HB, Bertolucci PHF. Treatment of dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s106en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT There is currently no cure for neurodegenerative or vascular dementias, but some pharmacological and non-pharmacological interventions may contribute to alleviate symptoms, slow disease progression and improve quality of life. Current treatment approaches are based on etiology, symptom profile and stage of dementia. This manuscript presents recommendations on pharmacological and non-pharmacological treatments of dementia due to Alzheimer’s disease, vascular cognitive impairment, frontotemporal dementia, Parkinson’s disease dementia, and dementia with Lewy bodies.
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Affiliation(s)
| | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Florindo Stella
- Universidade Estadual Paulista, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Tampi RR, Bhattacharya G, Marpuri P. Managing Behavioral and Psychological Symptoms of Dementia (BPSD) in the Era of Boxed Warnings. Curr Psychiatry Rep 2022; 24:431-440. [PMID: 35781675 DOI: 10.1007/s11920-022-01347-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview on the evaluation and management of behavioral and psychological symptoms of dementia (BPSD) using evidence from literature. RECENT FINDINGS Evidence indicates efficacy for some non-pharmacological techniques including education of caregivers and cognitive stimulation therapy and pharmacological agents like antidepressant and antipsychotics for the management of BPSD. The use of antipsychotics has generated controversy due to the recognition of their serious adverse effect profile including the risk of cerebrovascular adverse events and death. BPSD is associated with worsening of cognition and function among individuals with dementia, greater caregiver burden, more frequent institutionalization, overall poorer quality of life, and greater cost of caring for these individuals. Future management strategies for BPSD should include the use of technology for the provision of non-pharmacological interventions and the judicious use of cannabinoids and interventional procedures like ECT for the management of refractory symptoms.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA. .,Department of Psychiatry &Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA. .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. .,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. .,Department of Psychiatry, North East Medical University, Rootstown, OH, USA.
| | - Gargi Bhattacharya
- Department of Psychiatry &Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA
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Caramelli P, Marinho V, Laks J, Coletta MVD, Stella F, Camargos EF, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Chaves MLF, Brucki SMD, Nitrini R, Durgante HB, Bertolucci PHF. Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:88-100. [DOI: 10.1590/1980-5764-dn-2022-s106pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
RESUMO Atualmente não há tratamento curativo para as demências neurodegenerativas ou para a demência vascular, mas algumas intervenções farmacológicas e não farmacológicas podem contribuir para aliviar os sintomas, retardar a progressão da doença e melhorar a qualidade de vida. As abordagens terapêuticas atuais são baseadas na etiologia, no perfil dos sintomas e no estágio da demência. Neste artigo apresentamos recomendações sobre os tratamentos farmacológicos e não farmacológicos da demência devida à doença de Alzheimer, comprometimento cognitivo vascular, demência frontotemporal, demência da doença de Parkinson e demência com corpos de Lewy.
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Affiliation(s)
| | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Florindo Stella
- Universidade Estadual Paulista, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Kim D, Choi YR, Lee YN, Park WH, Chang SO. How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10493. [PMID: 36078209 PMCID: PMC9518535 DOI: 10.3390/ijerph191710493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.
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Affiliation(s)
- Dayeong Kim
- College of Nursing, Korea University, Seoul 02841, Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
| | - Young-Rim Choi
- College of Nursing, Korea University, Seoul 02841, Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong 18323, Korea
| | - Won-Hee Park
- College of Nursing, Korea University, Seoul 02841, Korea
| | - Sung-Ok Chang
- College of Nursing, Korea University, Seoul 02841, Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
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Grycuk E, Eichenholtz E, Aarsland D, Betzhold S, Daly G, Fitzpatrick R, Folkerts AK, Kalbe E, Kane JPM, Kinchin I, Saldanha IJ, Smith V, Taylor JP, Thompson R, Leroi I. Developing a core outcome set (COS) for Dementia with Lewy bodies (DLB). HRB Open Res 2022; 5:57. [PMID: 36619176 PMCID: PMC9772580 DOI: 10.12688/hrbopenres.13590.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 01/11/2023] Open
Abstract
Background: Dementia with Lewy bodies (DLB) is an important cause of dementia with a range of clinical manifestations, including motor, neuropsychiatric, and autonomic symptoms. Compared with more common forms of dementia such as Alzheimer's disease, DLB has been the focus of significantly fewer treatment studies, often with diverse outcome measures, making comparison and clinical implementation difficult. A core outcome set (COS) can address this by ensuring that data are comparable, relevant, useful, and usable for making the best healthcare decisions. Methods: Using a multi-stage approach, development of the DLB-COS will include the following stages: (1) A systematic review, following PRISMA guidelines to create an initial long list of outcomes; (2) A two-round online Delphi including clinicians, scientists, policymakers, and individuals with lived experience of DLB and their representatives; (3) An online consensus meeting to agree on the final core list of outcomes (the final DLB-COS) for use in research and clinical practice; (4) A literature search to identify appropriate measurement instruments for the DLB-COS outcomes; (5) A final consensus meeting of the professional stakeholders who attended the online consensus meeting to agree on the instruments that should be used to measure the outcomes in the DLB-COS; and (6) Global dissemination. Discussion: This is a multi-stage project to develop a COS to be used in treatment trials for DLB. A DLB-COS will ensure the selection of relevant outcomes and will identify the instruments to be used to measure DLB globally.
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Affiliation(s)
- Emilia Grycuk
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Ireland
| | - Emily Eichenholtz
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | | | - Gillian Daly
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Rachel Fitzpatrick
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Joseph PM Kane
- Centre for Public Health, Queens University Belfast, Northern Ireland, UK
| | - Irina Kinchin
- Global Brain Health Institute, and Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | | | - Valerie Smith
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | | | - Iracema Leroi
- Global Brain Health Institute, and Department of Psychiatry, Trinity College Dublin, Ireland
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Wang Z, Feng Y, Wang Y, Qiu H, Rui Z, Li M, Lv L. Meta-Analysis of the Efficacy and Safety of Olanzapine versus Clozapine when Treating Senile Dementia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5046761. [PMID: 35991140 PMCID: PMC9388268 DOI: 10.1155/2022/5046761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Objective To systematically assess the safety and efficacy of olanzapine versus clozapine when treating senile dementia and to provide evidence-based medicine basis for its promotion and use. Methods PubMed, Embase, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) online database were searched for randomized controlled trials (RCT) of olanzapine and clozapine when treating senile dementia. The retrieval time limit is from the establishment of the database to the present. The data were extracted independently by two researchers, and the bias risk of each contained literature was analyzed in accordance with the standard of Cochrane Handbook 5.3. RevMan 5.4 statistical software was used to analyze the collected data by meta-analysis. Results Finally, 6 randomized controlled trial articles were included, with a total of 490 samples. Meta-analysis of clinical efficacy showed that the clinical efficacy was similar and there was no significant difference (P > 0.05). Two articles used Alzheimer's disease pathological behavior rating scale (BEHAVE-AD) to compare the pathological behavior of different stages after treatment. Statistical analysis showed that there was no significant difference between the total score of BEHAVE-AD and the scores of each factor in each week after treatment. The non-treatment adverse reaction scale (TESS) of the study group and the control group was analyzed by meta-analysis. The TESS score of the study group after treatment was significantly lower than that of the control group. The BPRS scores of different stages after treatment were analyzed by meta-analysis, and there was no significant difference in the total score and factor scores of BPRS in each week after treatment. Two clinical trials reported the incidence of neurological symptoms after treatment. Olanzapine and clozapine treatment can effectively reduce the risk of aging. There was no significant difference in the incidence of neurological symptoms in patients with dementia (P > 0.05). According to the analysis of meat products, the incidence of adverse reactions in the study group was significantly lower than that in the control group (P < 0.05). Conclusion Olanzapine and clozapine have similar efficacy when treating mental and behavioral disorders in patients with senile dementia, in which olanzapine is more effective in improving the symptoms of patients with Alzheimer's disease (AD), with less adverse reactions and high safety, which is worth popularizing in clinical practice. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.
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Affiliation(s)
- Zongqin Wang
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Yingying Feng
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Yanyan Wang
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Hui Qiu
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Zhongyang Rui
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Mingxing Li
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Lihua Lv
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
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49
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Gerlach LB, Maust DT, Kales HC, Chang M, Kim HM, Wiechers IR, Zivin K. Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes. Am J Psychiatry 2022; 179:544-552. [PMID: 35615813 PMCID: PMC9349465 DOI: 10.1176/appi.ajp.21060591] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) and the Centers for Medicare and Medicaid Services (CMS) each created initiatives to reduce off-label use of antipsychotics in patients with dementia in nursing homes. Although CMS has reported antipsychotic reductions, the impact on prescribing of antipsychotic and other CNS-active medications in the VHA remains unclear. The authors evaluated national trends in antipsychotic and other CNS-active medication prescribing for nursing home patients with dementia in the VHA. METHODS The study sample was all veterans with dementia residing in VHA nursing homes for more than 30 days (N=35,742). Using an interrupted time-series design, the quarterly prevalences of antipsychotic, antidepressant, antiepileptic, anxiolytic, opioid, and memory medication prescribing were evaluated from FY2009 through FY2018. RESULTS Antipsychotic prescribing in VHA nursing homes declined from FY2009 to FY2018 (from 33.7% to 27.5%), with similar declines in anxiolytic prescribing (from 33.5% to 27.1%). During this period, prescribing of antiepileptics, antidepressants, and opioids increased significantly (antiepileptics: from 26.8% to 43.3%; antidepressants: from 56.8% to 63.4%; opioids: from 32.6% to 41.2%). Gabapentin served as the main driver of antiepileptic increases (from 11.1% to 23.5%). Increases in antidepressant prescribing included sertraline, mirtazapine, and trazodone. From FY2009 to FY2018, the overall prescribing of non-antipsychotic psychotropic medications grew from 75.0% to 81.1%. CONCLUSIONS Antipsychotic and anxiolytic prescribing for VHA nursing home residents with dementia declined, although overall prescribing of other psychotropic and opioid medications increased. Policies focused primarily on reducing antipsychotic use without considering use in the context of other medications may contribute to growth in alternative medication classes with even less evidence of benefit and similar risks.
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Affiliation(s)
- Lauren B. Gerlach
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Helen C. Kales
- Department of Psychiatry, University of California Davis, Sacramento, California
| | - Myron Chang
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - H. Myra Kim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Center for Statistical Consulting and Research, University of Michigan, Ann Arbor, Michigan
| | - Ilse R. Wiechers
- Office of Mental Health and Suicide Prevention, U.S. Dept. of Veterans Affairs,Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kara Zivin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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50
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Tampi RR, Jeste DV. Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management. Am J Psychiatry 2022; 179:528-543. [PMID: 35921394 DOI: 10.1176/appi.ajp.20220508] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuropsychiatric symptoms of dementia (NPS) are a group of noncognitive symptoms that occur in over 90% of individuals with dementia. NPS seem to result from a complex interaction among various biological, psychosocial, and environmental factors, and they are associated with greater morbidity and mortality, higher caregiver burden and burnout, high risk of nursing home placement, and increased cost of care for patients with dementia. Use of standardized assessment tools like the Neuropsychiatric Inventory can assist with qualifying and quantifying NPS. In this review, the authors evaluate the evidence for efficacy and safety of nonpharmacological and pharmacological interventions for treating NPS, mostly based on published meta-analyses. Commonly prescribed medications include atypical antipsychotics, acetylcholinesterase inhibitors, memantine, antidepressants, and mood stabilizers. There are also limited data on cannabinoids, repetitive transcranial magnetic stimulation, and ECT in individuals with NPS. Available evidence indicates that several nonpharmacological interventions are beneficial in the management of NPS and are recommended as first-line treatments. Pharmacotherapy should be reserved for the treatment of more severe or refractory NPS or where nonpharmacological management is not feasible. Atypical antipsychotics have shown mostly modest benefit in reducing NPS, and their use is limited by their adverse effect profiles. Recent investigations suggest potential strategies for preventing or at least reducing the risk of dementia and NPS. The authors conclude with brief guidelines for clinical practice as well as future research.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha (Tampi); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Tampi); Department of Psychiatry, Department of Neurosciences, and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego (Jeste)
| | - Dilip V Jeste
- Department of Psychiatry, Creighton University School of Medicine, Omaha (Tampi); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Tampi); Department of Psychiatry, Department of Neurosciences, and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego (Jeste)
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