Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

Abstract

Decision-making is considered a fundamental aspect of personal autonomy and can be affected in psychiatric and neurologic diseases. It has been shown that cognitive deficits in dementia impact negatively on decision-making. Moreover, studies highlighted impaired clinical competence in neuropsychiatric disorders, such as schizophrenia and bipolar disorder. In this context, the current study explored the relationship between behavioral and psychological symptoms of dementia (BPSD) and clinical competence, especially the capacity to consent to treatment, in Alzheimer’s disease (AD). Seventy-one patients with mild to moderate AD participated, completing assessments for capacity to consent to treatment, general cognition and neuropsychiatric disturbances. For each neuropsychiatric symptom, patients with and without the particular disturbance were compared on the different subscales of the MacArthur Competence Tool for Treatment (MacCAT-T; Understanding, Appreciation, Reasoning and Expression). The results showed that patients presenting delusions, as well as apathetic patients, had a lower ability to express a clear treatment choice compared to patients without these symptoms. By contrast, patients with dysphoria/depression had higher scores on this variable. Additionally, AD patients with euphoria had more difficulties discussing consequences of treatment alternatives compared to patients without this disturbance. None of the differences were confounded by global cognition. There were no between-group differences in clinical decision-making for patients with hallucinations, agitation/aggression, anxiety, irritability, disinhibition and aberrant motor behavior. These findings highlight the importance of taking BPSD into account when assessing decision-making capacity, especially clinical competence, in AD. Furthermore, reducing BPSD may lead to better clinical competence in patients with AD, as well as to improvements in patients and caregivers’ quality of life.

Perceptions, Experiences, and Challenges of Physicians Involved in Dementia Care During the COVID-19 Lockdown in India: A Qualitative Study

“…While the need for dependency and care is acknowledged, our participants felt it essential to balance it by preserving the autonomy of the PwD. While autonomy is an ethical construct that demands the highest advocacy, studies have reported that autonomy restriction can further increase the behavioral problems related to dementia ( 40 ). Some of the important factors leading to abuse according to our study could be poor knowledge about managing BPSD among the caregivers, caregiver burden, restriction of autonomy, and limitations of virtual consultations.…”

<p>Precision Medicine of Sodium Benzoate for the Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)</p>

“…[4][5][6][7][8]36,37 Adverse effects of antipsychotics may counterpoise their benefits for the treatment of psychosis and agitation; 38 on the other hand, patients with stable BPSD symptoms under antipsychotics treatment may have better competence and more potential to improve in cognitive function. 39 In the current trial, around half of subjects (25/49 [51%] in the benzoate group; 22/48 [46%] in the placebo group) were receiving antipsychotics, 21 thereby perhaps reducing the potential of benzoate efficacy for not only psychotic symptoms but also cognitive impairment. Benzoate exerted antipsychotic properties in a mouse model 40 and in patients with schizophrenia.…”

Behavioral and Psychiatric Symptoms of Dementia and Rate of Decline in Alzheimer’s Disease

“…Interestingly, delusions may have a different impact on patients’ functioning than hallucinations or agitation. Bertrand and colleagues (Bertrand et al, 2017) found that patients with mild to moderate AD who had delusions had a decreased ability to express treatment choice preference, potentially impacting their ability to consent to medical care. In contrast, patients with hallucinations, agitation/aggression, and several other BPSD did not have weaknesses in decision-making abilities.…”