Somatic comorbidities and Alzheimer’s disease treatment

Abstract

Therapeutic strategies in Alzheimer’s disease (AD) must take into account the characteristics of elderly people, who often have somatic comorbidities. Moreover, demented patients are more frequently frailer than older people. They have a higher number of admissions to hospital, a greater prevalence of complications and an increased risk of death. Therapeutic decisions for these patients have to be approached cautiously: aging, a more elevated comorbidity/polytherapy index and frailty contribute to enhance the risk of pharmacological adverse events and drug interactions. The aim of the present study was to focus on risk–benefit profile of pharmacological therapy for AD in relation to somatic comorbidities that often affect these patients. A Medline search (from 2001 to 2012) was performed using as key words dementia, Alzheimer’s disease, drug treatment, somatic comorbidities, side effects/adverse events and elderly. Cholinesterase inhibitors (ChEIs) and memantine represent the main pharmacological strategies effective in reducing the progression of cognitive decline and functional loss in AD. Many conditions very common in the elderly may restrict the use of ChEIs and/or treatment efficacy in AD patients. Memantine has a good efficacy and tolerability profile with better safety in pulmonary, cardiovascular and central nervous system comorbidities compared to ChEIs. Drug interactions with memantine are also more favorable since they concern mostly drugs not commonly used in the elderly. Only a careful evaluation of the associated somatic diseases, taking into account different drugs safety indexes and tolerability, can lead to personalized treatment management, in order to maximize drug efficacy and optimize quality of life.

Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data

“…Approaches that have been evaluated include timely screening of short term health conditions, systematic pain management protocols, and appropriately targeted psychosocial intervention [29]. Clodomiro and colleagues explore the possibility of applying risk benefit approaches to prescription according to factors such as frailty and multi-morbidity, highlighting in particular the incompatibility of anti-cholinergic treatments with many other medications commonly prescribed in elderly care settings [30].…”

The Frequency and Causes of Physical Complications/ Adverse Events During the Hospitalization of Patients with Dementia

“…Patients svakako neophodno uzeti u obzir omjer koristi i štete njihove primjene (11,12). Bolesnici s demencijom su specifična psihijatrijska skupina koja zahtijeva oprezan terapijski pristup zbog njihove dobi, čestog komorbiditeta i uzimanja različitih medikamenata, većeg rizika od nuspojava i interakcije među lijekovima (2).…”

“…pneumonija bez febriliteta) i razvijati se vrlo brzo, neophodno je na vrijeme prepoznati problem (5). Potrebno je naglasiti da kod ovih bolesnika, čak i diskretna promjena u okruženju, a osobito dolazak na akutni odjel, može dodatno nepovoljno utjecati na psihičko i somatsko stanje bolesnika, uzrokovati komplikacije, intenzivno somatsko liječenje, dužu hospitalizaciju i veće troškove (1,2,6).…”

“…Due to the aging of the population, the proportion of the elderly in hospitals is increasing. The elderly population is also often associated with a greater number of chronic somatic diseases, especially for patients suffering from dementia (1,2). For dementia patients, the onset of somatic decompensation may lead to mental decompensation (e.g.…”

“…pneumonia without febrility) and can develop very quickly, it is necessary to identify the condition timely (5). It should be emphasized that in these patients, even a discrete environmental change, and especially admission to the acute ward, can additionally adversely affect the mental and somatic condition of the patient, causing somatic complications requiring intensive somatic treatment, longer hospitalization, and higher costs (1,2,6 Zbog dekompenziranih tjelesnih stanja koja su zahtijevala premještaj na somatski odjel (drugu bolnicu) u promatranom je razdoblju premješteno 28 % svih bolesnika (40,2 % muškaraca i 23 % žena), a od toga 39 % u prvih sedam dana od dolaska u bolnicu. Prosječno trajanje hospitalizacije u slučaju premještaja u somatsku bolnicu bilo je kod muškaraca 13,7 dana (događalo se od 1. do 60. dana), a kod žena 18,85 dana (događalo se od 1. do 67. dana).…”