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The Clinical Problem of Neuropsychiatric Signs and Symptoms in Dementia

Burke, Anna MD; Hall, Geri PhD, ARNP, GCNS, FAAN; Tariot, Pierre N. MD

CONTINUUM: Lifelong Learning in Neurology: April 2013 - Volume 19 - Issue 2, Dementia - p 382–396
doi: 10.1212/01.CON.0000429177.14354.83
Review Articles

Purpose of Review: This article reviews behavioral signs and symptoms of dementia that can lead to increased mortality, excessive cognitive and functional disability, early institutionalization, and increased caregiver burnout.

Recent Findings: Almost all patients with a dementia will develop significant behavioral disturbances at some point over the course of their illness. These behavioral signs and symptoms rarely fit into usual diagnostic classifications or meet full criteria for a formal major psychiatric disorder.

Summary: Treatment of behavioral signs and symptoms of dementia should include both pharmacologic and nonpharmacologic interventions. There are currently no treatments for these disturbances approved by the US Food and Drug Administration. Best judgment should be used in identifying dominant target symptoms and matching them to the most relevant drug class. Implementing nonpharmacologic interventions before the development of neuropsychiatric symptoms may prevent triggers related to a progressively lowered stress threshold and therefore is key in the treatment of all patients with a dementia.

Address correspondence to Dr Anna Burke, Banner Alzheimer’s Institute 901 East Willetta St, Phoenix, AZ 85006, anna.burke@bannerhealth.com.

Relationship Disclosure: Dr Burke reports no disclosure. Dr Hall has served as an expert witness for a legal case regarding a resident care facility. Dr Tariot has served as a consultant for Abbott Laboratories; AC Immune; Adamas Pharmaceuticals, Inc; Allergan, Inc; AstraZeneca; Avanir Pharmaceuticals, Inc; Avid Radiopharmaceuticals; Boehringer Ingelheim; Bristol-Myers Squibb Company; Eisai Co, Ltd; Elan Corporation; Eli Lilly and Company; Genentech, Inc; GlaxoSmithKline; MedAvante, Inc; Medivation, Inc; Merck & Co, Inc; Novartis AG; Otsuka Pharmaceutical Co, Ltd; Pfizer Inc; Sanofi-Aventis; Toyama Pharmaceutical Association; and Worldwide Clinical Trials, Inc. Dr Tariot holds stock options in Adamas Pharmaceuticals, Inc, recently forfeited options in MedAvante, Inc, and is a contributor to a patent titled “Biomarkers of Alzheimer’s Disease.” Dr Tariot receives research support from Abbott Laboratories; Alzheimer’s Association; Arizona Department of Health Services, AstraZeneca; Avid Radiopharmaceuticals; Bristol-Myers Squibb Company; Elan Corporation; Eli Lilly and Company; Genentech, Inc; GlaxoSmithKline; Medivation, Inc; Merck & Co, Inc; National Institute on Aging; National Institute of Mental Health; Pfizer Inc; and Toyama Pharmaceutical Association.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Burke discusses the unlabeled use of atypical antipsychotics, antidepressants, and anticonvulsants for the treatment of agitation in dementia. Dr Hall reports no disclosure. Dr Tariot discusses the unlabeled use of cholinesterase inhibitors and memantine for people with dementia, as well as the unlabeled use of antipsychotics, antidepressants, and anticonvulsants. Information on drugs is provided for general purposes only and not relied on for prescribing. Before prescribing any of the drugs discussed, the physician should be knowledgeable about the full prescribing information that can be obtained from the manufacturers.

© 2013 American Academy of Neurology