Recent advances in the management of neuropsychiatric symptoms in dementia. Issue 2 (March 2017)

• Record Type: Journal Article
• Authors: Forlenza, Orestes V.; Loureiro, Júlia Cunha; Pais, Marcos Vasconcelos; Stella, Florindo
• Is Part Of: Current opinion in psychiatry. Volume 30:Issue 2(2017:Mar.)
• Publication Date: 2017-03
• Subjects: behavioral and psychological symptoms of dementia -- cognition -- dementia -- neuropsychiatric symptoms -- nonpharmacological interventions -- neuropsychiatric symptoms -- pharmacological management; Psychiatry -- Periodicals; 616.89005
• DOI: 10.1097/YCO.0000000000000309
• Languages: English
• ISSNs: 0951-7367

Abstract

Abstract : Purpose of review: The present article addresses intriguing questions related to the clinical intervention in distinct neuropsychiatric syndromes of patients with dementia. Recent findings: We reviewed 154 articles published between 2015 and 2016 targeting psychopharmacological and nonpharmacological interventions, and safety-tolerability concerns. We selected 115 articles addressing the purpose of this study. Of these, 33 were chosen because they were dedicated to subtopics: agitation (42), depression (33), apathy (18), sleep disorders/anxiety (8), and psychosis (4). Clinical studies using both pharmacological (70) and nonpharmacological (37) interventions were considered; others were included for theoretical support. Regarding the methodological design, we found double-blind RCTs (17), single-blinded RCTs (4), open-label studies (18), case reports (5), cross-sectional or cohort studies (25), epidemiological papers (2), and expert reviews (44). This observation raises concerns about the overall methodological adequacy of a substantial proportion of studies in this field, which limits the potential of generalization of the findings. Finally, 18 studies were designed to determine safety-tolerability issues of psychotropic medications (6 were discussed). Summary: Effective and well tolerated treatment of neuropsychiatric syndromes in dementia remains a critically unsolved challenge. We understand that this is an extremely important area of research, and critically required to guide clinical decisions in geriatric neuropsychiatry.