Managing Behavioral and Psychological Symptoms of Dementia

Gerlach, Lauren B.; Kales, Helen C.

doi:10.1016/j.cger.2019.11.010

Cited by 37 publications

(38 citation statements)

References 50 publications

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“…17 Currently, there are no treatments for DRP that are approved by the U.S. Food and Drug Administration, so patients with DRP are often treated with off-label antipsychotic medication when symptoms become severe, dangerous, or cause significant distress to the patient. 18 Several clinical trials have noted minimal clinical benefits of antipsychotics on symptoms of DRP; however, the potential for adverse events, including stroke, acute cardiovascular events, metabolic events, pulmonary effects, irreversible cognitive decompensation, and death, is great. [19][20][21][22][23][24] Due to the increasing prevalence of dementia and the unmet need of an effective safe treatment option for DRP, it is important for payers and providers to understand the real-world clinical and economic burden of patients with DRP.…”

Section: What This Study Addsmentioning

confidence: 99%

Burden of illness among patients with dementia-related psychosis

Frazer

Abler

Halpern

et al. 2021

JMCP

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Depending on dementia type and disease progression, approximately 20%-70% of patients experience dementia-related psychosis (DRP), characterized by hallucinations and/or delusions resulting in worse clinical outcomes and greater caregiver burden compared with patients without DRP. OBJECTIVE: To compare real-world clinical events, health care resource utilization (HCRU), and health care costs among matched cohorts of DRP versus dementiaonly patients. METHODS: This retrospective database analysis examined commercial and Medicare Advantage with Part D enrollees aged ≥ 40 years with evidence of DRP and dementia from January 1, 2010, through March 31, 2017. The first observed indicator of psychosis (≥ 2 diagnoses and/or antipsychotic pharmacy fills) co-occurring with or following evidence of dementia (≥ 2 diagnoses and/ or dementia medication pharmacy fills) was the index date among patients with DRP. DRP patients were propensity score matched 1:1 to patients with dementia only based on demographics, comorbidities, dementia type, dementia severity, and pre-index all-cause HCRU. Continuous health plan enrollment ≥ 12 months before evidence of dementia What is already known about this subject • The presence of neuropsychiatric symptoms in patients with dementia is associated with greater impairments in activities of daily living, faster cognitive decline, increased health care costs, and worse quality of life and contributes to caregiver fatigue, distress, and depression, resulting in earlier institutionalization of patients in long-term care facilities.

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Section: What This Study Addsmentioning

confidence: 99%

Burden of illness among patients with dementia-related psychosis

Frazer

Abler

Halpern

et al. 2021

JMCP

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“…If the physician decides to prescribe antipsychotics, clinical guidelines recommend the exclusive usage of the following drugs: risperidone, olanzapine, quetiapine, and aripiprazole [12]. Nevertheless, several reviews in this subject emphasized that prior to treatment with antipsychotics, one should always consider that these drugs exert detrimental effects and provide limited efficacy [6,7,16]. The main explanation for the poor clinical performance of atypical antipsychotics in elderly patients is that these were approved specifically for the treatment of schizophrenia, which affects mostly younger adults with neurobiological in multiple neurotransmitter systems cause changes in the expression of specific receptors, which have a direct impact on the regular functioning of the central nervous system (CNS) [3,18].…”

Section: Overview Of Potential Druggable Targets For Pharmacological mentioning

confidence: 99%

“…Currently, a specifically approved pharmacotherapy for BPSD remains elusive. The most troublesome psychiatric events such as aggression and the remaining symptoms psychosis and agitation are addressed with atypical antipsychotics administered off-label [6]. However, the clinical efficacy of these drugs is unsatisfactory because a large percentage of patients do not respond or respond partially to the drugs [7].…”

Section: Introductionmentioning

confidence: 99%

Management of Dementia-Related Psychosis, Agitation and Aggression: A Review of the Pharmacology and Clinical Effects of Potential Drug Candidates

et al. 2020

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Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms of dementia, such as psychosis, aggression, agitation, and depression. Atypical antipsychotics are commonly prescribed off-label to manage certain symptoms, despite warnings from the regulatory agencies regarding the increased risk of mortality associated with their use in elderly patients. Moreover, these compounds display a limited clinical efficacy, mostly owing to the fact that they were developed to treat schizophrenia, a disease characterized by neurobiological deficits. Thus, to improve clinical efficacy, it has been suggested that patients with dementia should be treated with exclusively designed and developed drugs that interact with pharmacologically relevant targets. Within this context, numerous studies have suggested druggable targets that might achieve therapeutically acceptable pharmacological profiles. Based on this, several different drug candidates have been proposed that are being investigated in clinical trials for behavioral and psychological symptoms of dementia. We highlight the recent advances toward the development of therapeutic agents for dementia-related psychosis and agitation/ aggression and discuss the relationship between the relevant biological targets and their etiology. In addition, we review the compounds that are in the early stage of development (discovery or preclinical phase) and those that are currently being investigated in clinical trials for dementia-related psychosis and agitation/aggression. We also discuss the mechanism of action of these compounds and their pharmacological utility in patients with dementia.

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“…Risks with anti-psychotic medication outweigh its benefits in terms of BPSDs, and as such non-pharmacological treatments should be considered first (Dyer, Harrison, Laver, Whitehead, & Crotty, 2018;Gardette et al, 2012;Kales, Gitlin, & Lyketsos, 2015;Seitz et al, 2012;Wang et al, 2016). Non-pharmacological treatments are costeffective but are underused despite the fact that they can potentially reduce BPSDs without the risks associated with pharmacological treatment (Gerlach & Kales, 2018;Herrmann & Gauthier, 2008;Scales, Zimmerman, & Miller, 2018). To be successful, the caring of PWDs should be person-centred (Du Toit, Shen, & McGrath, 2018;Fazio, Pace, Flinner, & Kallmyer, 2018;McNiel & Westphal, 2018), meaning that care should be individualized and based on the fact that every PWD is unique.…”

Section: Introductionmentioning

confidence: 99%