Feasibility of Retrospective Assessments of Behavioral Symptoms in Alzheimer's Disease: A Preliminary Study of Postmortem Caregiver Reports

Studies of the behavioral symptoms in Alzheimer's disease (AD) would be facilitated if reliable reports could be obtained retrospectively, especially about symptoms in the final months of life when concurrent assessment is often not feasible. To evaluate such a method, we compared results of a telephone interview conducted after the patient's death with information provided by the same informant earlier, while the patient was living. Agreement between in-life and retrospective assessments was higher for psychotic symptoms than for depressive behaviors, suggesting that retrospective assessment of specific behavioral symptoms in AD is not uniformly reliable. More symptoms were retrospectively reported as the length of time between the last in-life evaluation and date of death increased, suggesting that there may be increased variety of behavioral symptoms observed by caregivers in the final stages of the disease.

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The ABC of Alzheimer's Disease: Behavioral Symptoms and Their Treatment

International Psychogeriatrics ◽

10.1017/s1041610203008652 ◽

2002 ◽

Vol 14 (S1) ◽

pp. 27-49 ◽

Cited By ~ 33

Author(s):

George T. Grossberg

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Treatment Options ◽

Lewy Body Dementia ◽

Economic Cost ◽

Brain Regions ◽

Behavioral Symptoms ◽

Psychotic Symptoms ◽

Ache Inhibitors ◽

Che Inhibitors

Behavioral and psychological symptoms of dementia (BPSD) are a common manifestation of Alzheimer's disease (AD) and other dementia syndromes. Patients experience prominent and multiple symptoms, which are both distressing and a source of considerable social, health, and economic cost. Development of symptoms is in part related to progressive neurodegeneration and cholinergic deficiency in brain regions important in the regulation of behavioral and emotional responses including the cortex, hippocampus, and limbic system. Cholinesterase (ChE) inhibitors offer a mechanism-based approach to therapy to enhance endogenous cholinergic neurotransmission. Studies using ChE inhibitors have demonstrated their clear potential to improve or stabilize existing BPSD. Differences have been noted between selective acetylcholinesterase (AChE) inhibitors (donepezil and galantamine) and dual ChE inhibitors (rivastigmine) in terms of treatment response. While donepezil has shown efficacy in moderate to severe noninstitutionalized AD patients, conflicting results have been obtained in mild to moderate patients and in nursing home patients. Galantamine has been shown to delay the onset of BPSD during a five-month study but has been otherwise poorly studied to-date. Both donepezil and galantamine have not as yet demonstrated efficacy in reducing psychotic symptoms or in reducing levels of concomitant psychotropic medication use. Studies with the dual ChE inhibitor rivastigmine in mild to moderately severe AD and in Lewy body dementia (LBD) have shown improvements in behavioral symptoms including psychosis. Improvements have been maintained over a period of up to two years. In addition, institutionalized patients with severe AD have shown symptomatic benefits with a reduction in the requirement for additional psychotropic drugs following treatment with rivastigmine. The psychotropic properties associated with rivastigmine may in part be mediated through effects on butyrylcholinesterase. Current treatment options are limited for patients with dementia syndromes other than AD. However, data concerning rivastigmine in patients with LBD and preliminary studies in Parkinson's disease dementia and vascular dementia suggest a role for ChE inhibitors across the spectrum of dementia syndromes. Finally, studies that incorporated a delayed start design demonstrate that ChE inhibitors may delay the progression of BPSD.

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Serotonergic Drugs: Agonists/Antagonists at Specific Serotonergic Subreceptors for the Treatment of Cognitive, Depressant and Psychotic Symptoms in Alzheimer's Disease

Current Pharmaceutical Design ◽

10.2174/1381612822666160127113524 ◽

2016 ◽

Vol 22 (14) ◽

pp. 2064-2071 ◽

Cited By ~ 8

Author(s):

Felix-Martin Werner ◽

Rafael Covenas

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Psychotic Symptoms ◽

Serotonergic Drugs

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Effect of antihypertensive drugs on cognition and behavioral symptoms of patients with Alzheimer’s disease: A meta-analysis

Current Pharmaceutical Biotechnology ◽

10.2174/1386207323666201211101720 ◽

2020 ◽

Vol 21 ◽

Author(s):

Roja Rahimi ◽

Shekoufeh Nikfar ◽

Masoud Sadeghi ◽

Mohammad Abdollahi ◽

Reza Heidary Moghaddam ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Randomized Clinical Trials ◽

Antihypertensive Drugs ◽

Meta Analysis ◽

Behavioral Symptoms ◽

Cochrane Library ◽

Mean Differences ◽

Global Impression Of Change ◽

State Examination

Background: It has been found that there is a link between hypertension and elevated risk of Alzheimer’s disease (AD). Herein, a meta-analysis based on randomized clinical trials (RCTs) was used to assess the effect of antihypertensive drugs on cognition and behavioral symptoms of AD patients. Method: The three databases – PubMed/Medline, Scopus, and Cochrane Library- were searched up to March 2020. The quality of the studies included in the meta-analysis was evaluated by the Jadad score. Clinical Global Impression of Change (CGIC) included in two studies, Mini-Mental State Examination (MMSE) included in three studies, and Neuropsychiatric Inventory (NPI) in three studies were the main outcomes in this systematic review. Results: Out of 1506 studies retrieved in the databases, 5 RCTs included and analyzed in the meta-analysis. The pooled mean differences of CGIC, MMSE, and NPI in patients with AD receiving antihypertensive drugs compared to placebo was -1.76 with (95% CI = -2.66 to -0.86; P=0.0001), 0.74 (95% CI = 0.20 to 1.28; P= 0.007), and -9.49 (95% CI = -19.76 to 0.79; P = 0.07), respectively. Conclusion: The findings of the present meta-analysis show that antihypertensive drugs may improve cognition and behavioral symptoms of patients with AD. However, more well-designed RCTs with similar drugs are needed to achieve more conclusive results.

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Machine learning based on the multimodal connectome can predict the preclinical stage of Alzheimer’s disease: a preliminary study

European Radiology ◽

10.1007/s00330-021-08080-9 ◽

2021 ◽

Author(s):

Haifeng Chen ◽

Weikai Li ◽

Xiaoning Sheng ◽

Qing Ye ◽

Hui Zhao ◽

...

Keyword(s):

Machine Learning ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Preclinical Stage ◽

Preliminary Study

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The individual course of neuropsychiatric symptoms in people with Alzheimer's and Lewy body dementia: 12-year longitudinal cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.2019.195 ◽

2019 ◽

Vol 216 (1) ◽

pp. 43-48 ◽

Cited By ~ 9

Author(s):

Audun Osland Vik-Mo ◽

Lasse Melvaer Giil ◽

Miguel Germán Borda ◽

Clive Ballard ◽

Dag Aarsland

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Neuropsychiatric Symptoms ◽

Personalised Medicine ◽

Lewy Bodies ◽

Lewy Body Dementia ◽

Psychotic Symptoms ◽

Primary Inclusion ◽

The Individual

IntroductionUnderstanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals.MethodPrimary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia).ResultsWe found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms.ConclusionsWe observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.

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