The Diagnosis and Treatment of Behavioral Disorders in Dementia

Kratz, Torsten

doi:10.3238/arztebl.2017.0447

Cited by 33 publications

(18 citation statements)

References 70 publications

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“…Rivastigmine additionally pseudo-irreversibly inhibits butyrylcholinesterase (BChE) (Weinstock, 1999), an enzyme that, like AChE, catalyzes the hydrolysis of acetylcholine. Besides the effect of AChE-I on cognitive symptoms, they can also improve BPSD not only in ADD (Cummings et al, 1994;Birks, 2006;Tan et al, 2014;Matsuzono et al, 2015;Kratz, 2017), but also in dementia in idiopatic Parkinson's disease (PDD) and dementia with Lewy bodies (DLB) (Rolinski et al, 2012;Mori et al, 2016). However, no improvement of BPSD has been detected under treatment with rivastigmine in one study (Birks et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Serum Concentrations of Cholinesterase Inhibitors in Patients With Alzheimer’s Dementia Are Frequently Below the Recommended Levels

et al. 2020

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Background: Acetylcholinesterase inhibitors (AChE-I) are recommended for the treatment of cognitive symptoms but also of behavioral and psychological symptoms in dementia. They are widely used not only in Alzheimer's disease, but also in other forms of dementia. Efficacy of treatment might depend on serum concentration of the respective AChE-I. Objective: In patients with mild to moderate Alzheimer's dementia, we measured serum concentrations of hepatically metabolized donepezil and renally excreted rivastigmine and investigated possible modifiers. Additionally, we looked at correlations between serum concentrations and efficacy for both drugs. Methods: Serum concentrations of donepezil and rivastigmine were measured by liquid chromatographytandem mass spectrometry (LC-MS/MS). Real-time quantitative polymerase chain reaction (PCR). Allele specific PCR were performed to determine CYP2D6 genotype and gene dose. Clinical efficacy was assessed by changes of the subtest wordlist delayed recall of the Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery (CERAD-NAB). Results: Sixty-seven patients treated with a stable dosage of donepezil 10 mg (n=41) or rivastigmine 9.5 mg (n=26) were included. Mean serum concentration of donepezil and rivastigmine were 41.2 and 6.5 ng/ml, respectively. Serum concentrations were below the recommended range in 73% of the subjects in the donepezil group and in 65% of the participants in the rivastigmine group. When applying a dose-related reference, ranges 63% of patients in the donepezil group and 32% in the rivastigmine group had concentrations below the expected range. Gene dose, sex, and duration of treatment significantly predicted donepezil serum concentration (p=0.046, p=0.001, p=0.030 respectively). Only for rivastigmine did the serum concentration significantly contribute

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Section: Introductionmentioning

confidence: 99%

Serum Concentrations of Cholinesterase Inhibitors in Patients With Alzheimer’s Dementia Are Frequently Below the Recommended Levels

et al. 2020

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“…The reported prevalence of NPS varies but has been documented to be as high as 96%. This includes verbal and physical agitation, aggression, disinhibition, irritability, affect lability, apathy, psychosis, depression, and anxiety [4,5]. Patients can present with one or more symptoms and although there have been efforts to classify these symptoms there is not a unique classification system, which could help clinicians determine treatment for target symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Psychological causes include depression, grief/loss, posttraumatic stress disorder, underlying primary psychotic and/or mood disorder, and anxiety. Lastly, environmental factors can also trigger symptoms and these include changes in home environment and caregivers, hospitalizations, and lack of trained caregivers [4,5]. One important consideration when recognizing NPS is differentiating it from delirium because their treatment approaches vary and delirium can present with negative outcomes with high mortality if left untreated [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Management of Neuropsychiatric Symptoms of Dementia: A Comprehensive Review of the Current Literature

Suarez¹,

Shafi²,

Lapid³

2019

obm geriatr

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Background: Dementia is a progressive and debilitating condition that affects millions of patients in the United States with an enormous impact on healthcare costs, caregivers, and society. Patients with dementia often experience dementia-related neuropsychiatric disturbances, commonly known as Behavioral and Psychological Symptoms of Dementia (BPSD) and more recently Neuropsychiatric symptoms (NPS) in dementia. These symptoms include verbal and physical agitation, aggression, disinhibition, affect lability, apathy, psychosis, depression, and anxiety. Symptom management is important to optimize quality of life, minimize further functional decline, and delay institutionalization. We aim to review the existing published literature on pharmacologic and non-pharmacologic management of NPS. Methods: PubMed, Google Scholar, and Cochrane were searched for available reviews, systematic reviews, meta-analysis, and randomized controlled trials on diagnostic tools and treatment strategies for NPS. Some of the searched terms used included, "neuropsychiatric symptoms of dementia treatment," "NPS treatment," "pharmacologic treatment NPS," "non-pharmacologic treatment NPS," "scales NPS." We also searched for the term "BPSD" instead of "NPS" and "neurocognitive disorder" instead of "dementia." Recent Findings: There are different treatment modalities to address NPS, including pharmacologic and non-pharmacologic approaches, but the evidence throughout the years has been controversial and mostly studied in Alzheimer's disease population making less generalizable to other dementia populations. Summary: NPS continues to be a prevalent and debilitating condition in the elderly population with dementia. Non-pharmacologic strategies continue to be the first-line treatment for NPS despite lack of strong evidence because of their potential benefit and absence of side effects. Conversely, pharmacologic strategies have a potential risk for side effects in addition to the lack of strong evidence about their benefits in NPS; therefore, deprescribing is an important consideration in the management of these patients.

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“…Cognitive impairments often go hand in hand with problematic behaviors: people with dementia often refuse care, for example, bathing. This type of behavior is perceived as a strain by nursing staff and can lead to conflicts (Kratz 2017). A qualification of treatment providers in dealing with patients with dementia is thus urgently required (Isfort et al 2014).…”

Section: Improvement In Dealing With Patients With a Cognitive Impairmentioning

confidence: 99%

Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative (Preprint)

Huenefeld¹,

Rodde²,

Bureick³

et al. 2018

Preprint

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Background. All figures on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act in order to adequately respond to the expected increase in geriatric patients in the next 15 years. Against this background, major importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector (physicians, care providers, therapists, social workers) often have little knowledge about the special treatment and care needs of the elderly, in particular in facilities without the specific assignment to provide care to geriatric patients.Objective. The "Qualitätsverbund Geriatrie Nord-West-Deutschland e.V." (QVG NWD, English: Quality network of geriatric medicine in north-west Germany) is the body responsible for the project; with its current 57 member organizations; it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. QVG NWD conducts binding, evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations. Method. Various instruments are utilized in the evaluation of qualification measures:Besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures in order to determine the starting point and is then continued during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program.Results. The before and after comparison of the treatment-related outcomes at the beginning and near the end of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines (inpatient / outpatient). The evaluation of the implementation of educational contents in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to training contents. Conclusion.The evaluation develops foundations for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multi-professional networks.Instruments and results will be published and provided to other health care networks and -institutions. QVG NWD will implement the results of the evaluation process in its member institutions.

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The Diagnosis and Treatment of Behavioral Disorders in Dementia

Cited by 33 publications

References 70 publications

Serum Concentrations of Cholinesterase Inhibitors in Patients With Alzheimer’s Dementia Are Frequently Below the Recommended Levels

Serum Concentrations of Cholinesterase Inhibitors in Patients With Alzheimer’s Dementia Are Frequently Below the Recommended Levels

Management of Neuropsychiatric Symptoms of Dementia: A Comprehensive Review of the Current Literature

Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative (Preprint)

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