Antipsychotic Dose-Sparing Effect with Addition of Memantine

2005 ◽  
Vol 39 (9) ◽  
pp. 1573-1576 ◽  
Author(s):  
Rebecca B Sleeper
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Surrogate Marker ◽  
Behavioral Symptoms ◽  
Behavioral Disturbances ◽  
Drug Classes ◽  
Problematic Behaviors ◽  
Dose Sparing ◽  
Sparing Effect ◽  
Medication Changes

OBJECTIVE: To describe a case of an antipsychotic-sparing effect achieved after the addition of memantine to the regimen of a patient with severe Alzheimer's disease and aggressive behavioral disturbances. CASE SUMMARY: A 78-year-old white man with severe Alzheimer's disease was receiving risperidone 2 mg 3 times daily for persistent aggressive and dangerous behavioral disturbances. Memantine was initiated, and the dose was titrated to 10 mg twice daily. The patient's response included improvement in functional status and resolution of problematic behaviors, allowing repeated reduction of the risperidone dose and ultimate discontinuation. DISCUSSION: Antipsychotics are often employed to treat behavioral disturbances for patients with Alzheimer's disease; however, the adverse effect potential of these agents remains a significant concern. Adjunctive medications that maintain or improve behavioral symptoms yet allow an antipsychotic-sparing effect are attractive. Such experiences have previously been described with other drug classes, but clinical experience is evolving with memantine. For this patient, the effect of this agent on behavioral symptoms and risperidone requirements is one example of such an antipsychotic-sparing effect. CONCLUSIONS: Response to memantine therapy may include behavioral improvements allowing a dose-sparing effect of antipsychotic medication. Changes in psychoactive drug burden may be a valuable surrogate marker of memantine's effects on behavior.

Dementia Behavior Disturbance Scale

1997 ◽  
Vol 8 (S3) ◽  
pp. 325-327 ◽  
Author(s):  
Serge Gauthier ◽  
Mona Baumgarten ◽  
Rubin Becker
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Behavioral Symptoms ◽  
Measurement Scales ◽  
Behavioral Disturbances ◽  
Double Blind ◽  
Antidementia Drugs ◽  
Noncognitive Symptoms ◽  
Functional Autonomy ◽  
Behavior Disturbance

In clinical practice, the behavioral disturbances seen in patients with dementia are helpful in determining disease severity and the need for support care. In patients with Alzheimer's disease, the early appearance of behavioral symptoms is associated with faster disease progression. Until recently, pharmaceutical companies have had little interest in developing drugs to treat behavioral disturbances, because the U.S. Food and Drug Administration, in the “Guidelines for the Clinical Evaluation of Antidementia Drugs” dated November 8, 1990, held that drugs acting on noncognitive symptoms associated with Alzheimer's disease would be “pseudospecific” (i.e., not targeted to the core cognitive domains of Alzheimer's disease). As a result, few measurement scales were specifically developed to assess functional autonomy and behavior in patients with Alzheimer's disease within time frames of 3 to 6 months, the typical length of double-blind, placebo-controlled studies. Many of the existing scales included heterogeneous items relevant to cognition, functional autonomy, somatic symptoms, and psychiatric problems. The Dementia Behavior Disturbance (DBD) scale was developed in the late 1980s, a time when the importance of behavioral symptoms in dementia was increasingly being recognized. Recent harmonization efforts for the development of antidementia drugs have further emphasized the clinical importance of noncognitive symptoms in dementia.

Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) Rating Scale

1997 ◽  
Vol 8 (S3) ◽  
pp. 301-308 ◽  
Author(s):  
Barry Reisberg ◽  
Stefanie R. Auer ◽  
Isabel M. Monteiro
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Psychiatric Disorders ◽  
Behavioral Problems ◽  
Rating Scale ◽  
Behavioral Symptoms ◽  
Functional Impairments ◽  
Behavioral Disturbances ◽  
Cognitive Disturbances ◽  
Behavioral Pathology

Before the development of the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) rating scale in 1987 by Reisberg and colleagues and its predecessor scale, the Symptoms of Psychosis in Alzheimer's Disease (SPAD) rating scale, in 1985 by Reisberg and Ferris, other scales were available for measuring behavioral disturbances and psychiatric disorders in patients with Alzheimer's disease. However, these scales generally mixed together cognitive disturbances with behavioral symptoms and sometimes included functional impairments as well. These predecessor scales also were not specifically designed to assess the types of behavioral problems seen in Alzheimer's disease. If a scale did address behavioral disturbances of dementia, it tended to be seriously underspecified in terms of the nature of behavioral disturbances.

scholarly journals 533 - “Agitation and End-of-Life: Towards an Advance Directive that Prepare for Agitation and Behavioral Symptoms in Alzheimer’s Disease”

2021 ◽  
Vol 33 (S1) ◽  
pp. 77-78
Author(s):  
Mary Chi Michael
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Behavioral Symptoms ◽  
Behavioral Disturbances ◽  
Psychiatric Advance Directives ◽  
Behavioral Aspects ◽  
Care And Treatment

AbstractAdvance Directives provide legal documentation of a person’s wishes regarding medical treatment and care, allowing people and their families to decide in advance how care and treatment should be provided at end-of-life when a person is no longer capable of making independent decisions. For people living with advanced stages of Alzheimer’s, Advance Directives give specific, life-altering instructions to ensure a person’s will is being met. Yet Advance Directives that anticipate for the eventualities of Alzheimer’s Disease often fail to specifically prepare for the care and treatment decisions prompted by agitation and other behavioral aspects of the disease. This is a major oversight.“Agitation and End-of-Life: Towards an Advance Directive that Prepare for Agitation and Behavioral Symptoms in Alzheimer’s Disease” proposes a framework for how Advance Directives can prepare for the unique decisions that arise as a person experiences agitation and other behavioral symptoms of Alzheimer’s.The framework proposed in this project draws from the recent development of Psychiatric Advance Directives led in part by the American Psychiatric Association, which have pioneered the use of Advance Directives for anticipated behavioral challenges. Specifically, Psychiatric Advance Directives allow individuals to specify in advance which treatments may be administered in response to acute episodes of psychiatric illness at a time when someone is unable or unwilling to provide consent. Our project contends that the mechanisms underlying Psychiatric Advance Directives be modeled but modified to help people, families, and providers prepare for agitation and the behavioral aspects of Alzheimer’s.Specifically, we propose a four-part framework for Advance Directives to prepare for agitation and other behavioral aspects of Alzheimer’s: 1.Psychiatric medications. What treatments may – or may not – be used to manage agitation or other behavioral disturbances?2.Agitation prevention and de-escalation. What strategies and techniques can caregivers employ to mollify agitated behaviors? How should caregivers respond to episodes of agitation?3.Lifestyle preferences and values. What values – religious or otherwise – should guide care and treatment?4.Information sharing and access. When and how should caregivers, medical professionals, and family members be notified – or share information about – behavioral disturbances?It is well established in the scientific and medical literature that agitation and behavioral aspects of Alzheimer’s can cause severe difficulty for families as the disease progresses. Advance Directives that prepare for agitation can help to create a plan and ease the challenges prompted by agitation and other behavioral aspects of Alzheimer’s.

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

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.

P4-182: The behavioral disturbances in mild-moderate and severe stages of Alzheimer's disease

2006 ◽  
Vol 2 ◽  
pp. S569-S570
Author(s):  
Mari Feli Gonzalez ◽  
Javier Yanguas ◽  
Cristina Buiza ◽  
Igone Etxeberria ◽  
Nerea Galdona ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Behavioral Disturbances

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

2006 ◽  
Vol 54 (9) ◽  
pp. 1348-1354 ◽  
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

Changes in emotional and behavioral symptoms of Alzheimer's disease

2000 ◽  
Vol 15 (3) ◽  
pp. 176-179 ◽  
Author(s):  
Michelle M. Lee ◽  
Milton E. Strauss ◽  
Deborah V. Dawson
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Behavioral Symptoms

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

2002 ◽  
Vol 14 (S1) ◽  
pp. 27-49 ◽  
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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