Changes in emotional and behavioral symptoms of Alzheimer's disease

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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Four Components Describe Behavioral Symptoms in 1,120 Individuals with Late-Onset Alzheimer's Disease

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2006.00854.x ◽

2006 ◽

Vol 54 (9) ◽

pp. 1348-1354 ◽

Cited By ~ 88

Author(s):

Paul Hollingworth ◽

Marian L. Hamshere ◽

Valentina Moskvina ◽

Kimberley Dowzell ◽

Pamela J. Moore ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Late Onset ◽

Behavioral Symptoms

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Pharmacological Approaches to Behavioral Symptoms in Alzheimer's Disease

Alzheimer's Disease ◽

10.1201/9781420048407.ch21 ◽

1996 ◽

Author(s):

Douglas Galasko

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Behavioral Symptoms

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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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The Association Between Distinct Frontal Brain Volumes and Behavioral Symptoms in Mild Cognitive Impairment, Alzheimer's Disease, and Frontotemporal Dementia

Frontiers in Neurology ◽

10.3389/fneur.2019.01059 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 5

Author(s):

Antti Cajanus ◽

Eino Solje ◽

Juha Koikkalainen ◽

Jyrki Lötjönen ◽

Noora-Maria Suhonen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Frontotemporal Dementia ◽

Behavioral Symptoms ◽

Brain Volumes ◽

Frontal Brain

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Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil

Dementia & Neuropsychologia ◽

10.1590/s1980-57642010dn40100007 ◽

2010 ◽

Vol 4 (1) ◽

pp. 42-46 ◽

Cited By ~ 2

Author(s):

Cláudia Godinho ◽

Iulek Gorczevski ◽

Andréa Heisler ◽

Maria Otília Cerveira ◽

Márcia Lorena Chaves

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Functional Status ◽

Outpatient Clinic ◽

Daily Living ◽

Cognitive Testing ◽

Screening Tests ◽

Behavioral Symptoms ◽

Significant Difference ◽

Severity Of Dementia

Abstract The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out. Objectives: The goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil. Methods: A sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA), Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL) and application of the Neuropsychiatry Inventory (NPI) for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia. Results: Of the whole sample, 71% were female. Age was 79±8 years (mean±SD). Educational level was 4±3 years (mean±SD). Sixty-four patients (60%) presented the diagnosis of Alzheimer's disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE) and functional status scores was observed among the CDR categories (severity). No significant association was found between severity and impairment on memory tests and behavioral symptoms. Conclusions: Alzheimer's disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause.

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