Gender, aggression and serotonergic function are associated with response to sertraline for behavioral disturbances in Alzheimer's disease

Lanctôt, Krista L.; Herrmann, Nathan; Reekum, Robert van; Eryavec, Goran; Naranjo, Claudio A.

doi:10.1002/gps.636

Cited by 56 publications

(21 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a serotonergic deficit in AD (Whitford, 1986), and reductions in 5-HT have been associated with hostility, impulsivity and aggression in other neuropsychiatric patient populations (Duke et al, 2013). Consistent with the hypothesis that serotonergic deficits may be associated with agitation, three studies measured the prolactin response to d,lfenfluramine (an indirect central 5-HT agonist) and found that aggressive or agitated AD patients had higher 5-HT responsivity (Lanctôt et al, 2002a(Lanctôt et al, , 2002bMintzer et al, 1998)), plausibly due to an overall decline in central 5-HT function with compensatory upregulation of remaining postsynaptic receptors. A further study reported decreased central 5-HT uptake together with lower platelet 3 H-imipramine binding density in an agitated AD group (Schneider et al, 1988).…”

Section: Serotoninmentioning

confidence: 88%

The neurochemistry of agitation in Alzheimer’s disease: a systematic review

Liu

Stringer

Reeves

et al. 2018

Ageing Research Reviews

View full text Add to dashboard Cite

Disruption of the dynamic balance between multiple neurotransmitter systems could impair functional neural networks involved in affective regulation and executive function. Differences in study design and methodology may have contributed to conflicting findings. Future studies that overcome these limitations (e.g. using standardized criteria to define agitation) and employ neuroimaging methods such as MRI/PET to investigate specific neural networks are needed to clarify the role of neurotransmitter alterations in these patients.

show abstract

Section: Serotoninmentioning

confidence: 88%

The neurochemistry of agitation in Alzheimer’s disease: a systematic review

Liu

Stringer

Reeves

et al. 2018

Ageing Research Reviews

View full text Add to dashboard Cite

show abstract

“…Concerning cholinesterase inhibitors, one meta-analysis showed that rivastigmine had positive effects on nonpsychotic and psychotic symptoms associated with Alzheimer’s disease [35]. Among antidepressants, citalopram has for example showed significant efficacy against behavioral disturbances in individuals with dementia [36,37], and sertraline has showed efficacy against aggressive behavior [38]. Selective serotonin reuptake inhibitors are also recommended as first line treatment for irritability, agitation and anxiety among people with dementia [1].…”

Section: Discussionmentioning

confidence: 99%

Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units

Gustafsson

Karlsson

Lövheim

2013

BMC Pharmacol Toxicol

View full text Add to dashboard Cite

BackgroundAntipsychotic drugs are widely used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), despite their limited efficacy and concerns about safety. The aim of this study was to describe antipsychotic drug therapy among people with dementia living in specialized care units in northern Sweden.MethodsThis study was conducted in 40 specialized care units in northern Sweden, with a total study population of 344 people with dementia. The study population was described in regard to antipsychotic drug use, ADL function, cognitive function and BPSD, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). These data were collected at baseline and six months later. Detailed data about antipsychotic prescribing were collected from prescription records.ResultsThis study showed that 132 persons (38%) in the study population used antipsychotic drugs at the start of the study. Of these, 52/132 (39%) had prescriptions that followed national guidelines with regard to dose and substance.After six months, there were 111 of 132 persons left because of deaths and dropouts. Of these 111 people, 80 (72%) were still being treated with antipsychotics, 63/111 (57%) with the same dose. People who exhibited aggressive behavior (OR: 1.980, CI: 1.515-2.588), or passiveness (OR: 1.548, CI: 1.150-2.083), or had mild cognitive impairment (OR: 2.284 CI: 1.046-4.988), were at increased risk of being prescribed antipsychotics.ConclusionThe prevalence of antipsychotic drug use among people with dementia living in specialized care units was high and inappropriate long-term use of antipsychotic drugs was common.

show abstract

“…For example, the demonstration of a central nervous system (CNS) serotonergic deficit in AD has stimulated preliminary trials of selective serotonin reuptake inhibitors (SSRIs) for disruptive behaviors in AD. 7,8 Also, reduced incidence and severity of behavioral problems in AD patients treated with cholinesterase inhibitors suggests that the CNS cholinergic deficit in AD contributes to the pathophysiology of disruptive behavior and other behavioral symptoms in this disorder. [9][10][11] Another behaviorally important neurotransmitter system that is substantially affected by AD is the CNS noradrenergic system.…”

mentioning

confidence: 98%

Propranolol for Disruptive Behaviors in Nursing Home Residents With Probable or Possible Alzheimer Disease

Peskind

Tsuang²,

Bonner³

et al. 2005

Alzheimer Disease &Amp; Associated Disorders

125

View full text Add to dashboard Cite

Short-term propranolol augmentation treatment appeared modestly effective and well tolerated for overall behavioral status in nursing home residents with probable or possible AD complicated by disruptive behaviors. Propranolol may be helpful specifically for aggression and uncooperativeness (the behaviors assessed by the NPI "agitation/aggressiveness" item). However, the usefulness of propranolol in this very old and frail population was limited by the high frequency of relative contraindications to beta-adrenergic antagonist treatment and diminution of initial behavioral improvements over time.

show abstract

Gender, aggression and serotonergic function are associated with response to sertraline for behavioral disturbances in Alzheimer's disease

Abstract: Aggression, gender and serotonergic function were associated with sertraline response. Larger randomized controlled trials are needed to clarify the profile of responders.

Cited by 56 publications

References 88 publications

The neurochemistry of agitation in Alzheimer’s disease: a systematic review

The neurochemistry of agitation in Alzheimer’s disease: a systematic review

Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units

Propranolol for Disruptive Behaviors in Nursing Home Residents With Probable or Possible Alzheimer Disease

Contact Info

Product

Resources

About