Role of Cholinesterase Inhibitors in Managing Behavioral Problems in Alzheimer's  Disease

Masterman, Donna

doi:10.4088/pcc.v06n0304

Cited by 7 publications

(5 citation statements)

References 54 publications

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“…Donepezil hydrochloride, galantamine hydrobromide, and rivastigmine tartrate are some of the conventionally administered ChEIs that are currently being used as part of the primary treatment for cognitive improvement in AD patients [280]. Recent clinical trials where AD patients were administered ChEIs also demonstrated their benefit for neuropsychiatric and behavioural symptoms [281]. Similar patterns are observed in the management of dementia with Lewy bodies as well as cognitive impairment associated with PD [282].…”

Section: Cholinesterase Inhibitorsmentioning

confidence: 67%

Neurochemicals, Behaviours and Psychiatric Perspectives of Neurological Diseases

Choudhury¹,

Sahu²,

Ramanujam³

et al. 2018

Neuropsychiatry

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Structural changes in different regions of the brain have become clinically relevant and regarded as the signature phenomenon for neurological diseases. Morphological changes in brain are also associated with neuronal and neurochemical alterations. Studies have showed that minute changes in neurochemical levels may have marked impact on the psychobehaviour of the subject. Several neurological disease profiles have been reported with such specific psychobehavioural expression. However, application of behavioural abnormalities as possible disease progress markers has not been considered and emphasised much. Reports suggested that-the subjects, who have already entered into the terminal stage of the disease, used to show cardinal behavioural signs for a specific disease profile. However, psychological expressions are comparatively early expressive. As most of the neurodegenerative disorders are unidirectional and progressive by nature, therapeutic intervention at the right time is essential for attaining the desired outcome. Moreover, early diagnosis can aid in managing the disease progression also. Psychobehavioural analysis could meet the expected outcome of disease diagnosis if implemented properly and timely. In the present review, we have amalgamated the reported behavioural anomalies with the supportive background from neurochemical basis. Further, we have concluded that behaviour centric studies could be a potential diagnostic tool for the early diagnosis of major neurological diseases such as Alzheimer disease, Parkinson's disease, Amyotrophic lateral sclerosis (ALS), Bipolar disorder, Schizophrenia, Impulse control disorder (ICD) and Obsessive-compulsive disorder (OCD).

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Section: Cholinesterase Inhibitorsmentioning

confidence: 67%

Neurochemicals, Behaviours and Psychiatric Perspectives of Neurological Diseases

Choudhury¹,

Sahu²,

Ramanujam³

et al. 2018

Neuropsychiatry

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“…We examined medications used to address agitation during the first seven days of hospitalization. Psychotropic drugs of interest included: antipsychotics (e.g., risperidone, olanzapine, quetiapine, haloperidol), ( 14 ) cholinesterase inhibitors, ( 15 ) memantine, ( 16 ) antidepressants (e.g., citalopram, sertraline, mirtazapine), ( 17 ) anticonvulsants (valproic acid, pregabalin), ( 17 ) and benzodiazepines, ( 14 ) as well as any of these medications that were taken ‘as needed’ (PRN – pro re nata). The medication administration chart was used to identify which medications of which patients received at least one dose.…”

Section: Methodsmentioning

confidence: 99%

Management of Agitation in Dementia and Effects on Inpatient Length of Stay

Silverstone-Simard

Nassim

et al. 2021

Can Geri J

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Background Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients’ ‘dischargeability’ (i.e., amount of time until a patient is considered dischargeable from an inpatient unit). Methods This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used. Results Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, p = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, p = .027), and as-needed (‘PRN’) benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, p = .006) were independently associated with prolonging time until dischargeable. Conclusions Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting.

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“…In a recent study, suppression of cholinergic interneurons in rats striatum led to the development of repeated ritualized behavior (15). Several reports have pointed out the possible role of cholinergic disturbance in neuropsychiatric manifestations of dementia (16,17). It appears that acetylcholinesterase inhibitors have psychotropic effects and might play a beneficial role in controlling behavioral and psychological symptoms of dementia (BPSD) such as agitation, apathy, and psychosis (18).…”

Section: Comorbidity Of Ocd With Dlb Might Be Incidentalmentioning

confidence: 99%

Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases

2020

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Objectives: Obsessive-compulsive disorder usually begins in adolescence or young adulthood. OCD cases appearing after the age of 50 years are rare, most often associated with inflammatory, brain lesions, or neurodegenerative comorbidities. We describe two cases of late-onset obsessive compulsive disorder followed by the development of Dementia with Lewy Bodies and review the links between these two disorders. Methods and Results: We describe the clinical history of two patients that first showed OCD symptoms at an atypical age (>60 years). After several failed treatment attempts, they were hospitalized in our unit. Both presented severe sensitivity to antipsychotic agents that led to a diagnosis of Dementia with Lewy Bodies. Administration of cholinesterase inhibitors was associated with decrease of psychiatric symptoms in both cases. In addition to those clinical observations, a systematic review of the literature suggests that, beyond prefrontal cortex, temporal lobe and putamen have important roles in OCD pathophysiology. Based on these findings, we discuss four hypotheses to explain the sequential appearance of OCD and DLB symptoms. First, we considered the possibility that comorbidity of OCD with DLB was coincidental. Second, we propose to interpret OCD symptoms as motor stereotypies. Third, we hypothesize that late-onset OCD might be a symptom of late-onset depression. Four, we hypothesize that through early deterioration of basal ganglia, DLB caused the onset of OCD. Conclusion: In conclusion, we recommend that cases of late-onset treatment-resistant OCD should be carefully tested for possible organic etiologies, and for DLB in particular.

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Role of Cholinesterase Inhibitors in Managing Behavioral Problems in Alzheimer's Disease

Cited by 7 publications

References 54 publications

Neurochemicals, Behaviours and Psychiatric Perspectives of Neurological Diseases

Neurochemicals, Behaviours and Psychiatric Perspectives of Neurological Diseases

Management of Agitation in Dementia and Effects on Inpatient Length of Stay

Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases

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