Management of Neuropsychiatric Symptoms in People with Dementia

详细信息    查看全文

• 作者：Prof. Clive Ballard (1)
  Anne Corbett (1)
  
• 刊名：CNS Drugs
• 出版年：2010
• 出版时间：September 2010
• 年：2010
• 卷：24
• 期：9
• 页码：729-739
• 全文大小：153KB
• 参考文献：1. Prince M. Epidemiology of Alzheimer’s. Psychiatry 2004; 3: 11- CrossRef
  2. Ballard C, Ayre G, Gray A. psychotic symptoms and behavioural disturbances in dementia: a review. Rev Neurol 1999; 155: 44-2
  3. Steinberg M, Shao H, Zandi P, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry 2008; 23: 170- CrossRef
  4. Aalten P, de Vugt ME, Lousberg R, et al. Behavioral problems in dementia: a factor analysis of the Neuropsychiatric Inventory. Dement Geriatr Cogn Disord 2003; 15: 99-05 CrossRef
  5. Burns A, Jacoby R, Levy R. Psychiatric phenomena in Alzheimer’s disease: IV. Disorders of behaviour. Br J Psych 1990; 157: 86-4 CrossRef
  6. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American J Psych 2000; 157: 708-4 CrossRef
  7. Margallo-Lana M, Swann A, O’Brien J, et al. Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. Int J Geriatric Psych 2001; 16: 39-4 CrossRef
  8. Gilley DW, Whalen ME, Wilson RS, et al. Hallucinations and associated factors in Alzheimer’s disease. J Neuropsych Clin Neurosci 1991; 3: 371-
  9. Rabins PV, Mace NL, Lucas MJ. The impact of dementia on the family. J Am Med Soc 1982; 248: 333-
  10. Ballard CG, Eastwood C, Gahir M, et al. A follow up study of depression in the carers of dementia sufferers. BMJ 1996; 312: 947 CrossRef
  11. Steele C, Rovner B, Chase GA, et al. Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease. Am J Psych 1990; 147: 1049-1
  12. Ballard C, Howard R. Neuroleptic drugs in dementia: benefits and harm. Nat Rev Neurosci 2006; 7: 492-00 CrossRef
  13. McKeith I, Fairbairn A, Perry R, et al. Neuroleptic sensitivity in patients with senile dementia of Lewy body type. BMJ 1992; 305: 673- CrossRef
  14. Lyketsos CG, Colenda CC, Beck C, et al. Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia due to Alzheimer disease. Am J Geriatr Psychiatry 2006; 14: 561-2 CrossRef
  15. Livingston G, Johnston K, Katona C, et al. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005; 162: 1996-021 CrossRef
  16. Cohen-Mansfield J, Libin A, Marx MS. Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. J Gerontol A Biol Sci Med Sci 2007; 62: 908-6 CrossRef
  17. Bird M. Psychosocial approaches to challenging behaviour in dementia: a controlled trial. In: Report to the Commonwealth Department of Health and Ageing. Canberra (ACT): Office for Older Australians, 2002
  18. Rovner BW, Steele CD, Shmuely Y, et al. A randomized trial of dementia care in nursing homes. J Am Geriatr Soc 1996; 44: 7-3
  19. Fossey J, Ballard C, Juszczak E, et al. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ 2006; 332: 756-1 CrossRef
  20. Chenoweth L, King MT, Jeon YH, et al. Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurol 2009; 8: 317-5 CrossRef
  21. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA 2003; 290: 2015-2 CrossRef
  22. National Institute for Health and Clinical Excellence. NICE SCIE guideline to improve care of people with dementia, 22 November 2006 [online]. Available from URL: http://www.nice.org.uk/guidance/index.jsp?action=download&r=true&o=30323 [Accessed 2010 Jun 14]
  23. Ballard CG, O’Brien JT, Reichelt K, et al. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry 2002; 63: 553- CrossRef
  24. Lin PW, Chan WC, Ng BF, et al. Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial. Int J Geriatr Psychiatry 2007; 22: 405-0 CrossRef
  25. Burns A, Byrne J, Ballard C, et al. Sensory stimulation in dementia. BMJ 2002; 325: 1312- CrossRef
  26. Holmes C, Hopkins V, Hensford C, et al. Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. Int J Geriatr Psychiatry 2002; 17: 305- CrossRef
  27. Smallwood J, Brown R, Coulter F, et al. Aromatherapy and behaviour disturbances in dementia: a randomized controlled trial. Int J Geriatr Psychiatry 2001; 16: 1010- CrossRef
  28. Schneider LS, Pollock VE, Lyness SA. A meta-analysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990; 38: 553-3
  29. Finkel SI, Lyons J, Andrerson R, et al. A randomized, placebo-controlled trial of thiothixene in agitated, demented nursing home patients. Int J Geriatr Psychiatry 1995; 10: 129-6 CrossRef
  30. De Deyn PP, Rabheru K, Rasmussen A, et al. A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999; 53: 946-5 CrossRef
  31. Teri L, Logsdon RG, Peskind E, et al. Treatment of agitation in AD: a randomized, placebo-controlled clinical trial. Neurology 2000; 55: 1271- CrossRef
  32. Lonergan E, Luxenberg J, Colford J, et al. Haloperidol for agitation in dementia. Cochrane Database Syst Rev 2005; (4): CD002852
  33. Allain H, Dautzenberg PHJ, Maurer K, et al. Double blind study of tiapride versus haloperidol and placebo in agitation and aggressiveness in elderly patients with cognitive impairment. Psychopharmacology 2000; 148(4): 361- CrossRef
  34. Auchus AP, Bissey-Black C. Pilot study of haloperidol, fluoxetine, and placebo for agitation in Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 1997; 9: 591-
  35. De Deyn PP, Rabheru K, Rasmussen A, et al. A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999; 53: 946-5 CrossRef
  36. Devanand DP, Marder K, Michaels KS, et al. A randomized, placebo-controlled dose-comparison trial of haloperidol for psychosis and disruptive behaviors in Alzheimer’s disease. Am J Psychiatry 1998; 155: 1512-0
  37. Cowley LM, Glen RS. Double-blind study of thioridazine and haloperidol in geriatric patients with a psychosis associated with organic brain syndrome. J Clin Psychiatry 1979; 40: 411-
  38. Barnes R, Veith R, Okimoto J, et al. Efficacy of antipsychotic medications in behaviourally disturbed dementia patients. Am J Psychiatry 1982; 139: 1170-
  39. Stotsky B. Multicenter study comparing thioridazine with diazepam and placebo in elderly, nonpsychotic patients with emotional and behavioural disorders. Clin Ther 1984; 6(4): 546-9
  40. Pollock BG, Mulsant BH, Rosen J, et al. Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry 2002; 159(3): 460- CrossRef
  41. Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psych 2006; 14: 191-10 CrossRef
  42. Reisberg B, Auer SR, Monteiro IM. Behavioral and psychological signs and symptoms of dementia: implications for research and treatment theories behind scales and measurements. Int Psychogeriatr 1997; 8: 301- CrossRef
  43. Mintzer J, Greenspan A, Caers I, et al. Risperidone in the treatment of psychosis of Alzheimer disease: results from a prospective clinical trial. Am J Geriatr Psychiatry 2006; 14: 280-1 CrossRef
  44. Street JS, Clark WS, Gannon KS, et al. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group. Arch Gen Psychiatry 2000; 57: 968-6 CrossRef
  45. Streim JE, Porsteinsson AP, Breder CD, et al. A randomized, double-blind, placebo-controlled study of aripiprazole for the treatment of psychosis in nursing home patients with Alzheimer disease. Am J Geriatr Psychiatry 2008 Jul; 16(7): 537-0 CrossRef
  46. De Deyn P, Jeste DV, Swanink R, et al. Aripiprazole for the treatment of psychosis in patients with Alzheimer’s disease: a randomized, placebo-controlled study. J Clin Psycho-pharmacol 2005; 25: 463- CrossRef
  47. Mintzer JE, Tune LE, Breder CD, et al. Aripiprazole for the treatment of psychoses in institutionalized patients with Alzheimer dementia: a multicenter, randomized, double-blind, placebo-controlled assessment of three fixed doses. Am J Geriatr Psychiatry 2007; 15: 918-1 CrossRef
  48. Ballard C, Margallo-Lana M, Juszczak E, et al. Quetiapine and rivastigmine and cognitive decline in Alzheimer’s disease: randomised double-blind placebo-controlled trial. BMJ 2005; 330: 874 CrossRef
  49. Sultzer DL, Davis SM, Tariot PN, et al. Clinical symptom responses to atypical antipsychotic medications in Alzheimer’s disease: phase 1 outcomes from the CATIE-AD effectiveness trial. Am J Psychiatry 2008; 165: 844-4 CrossRef
  50. Schneider LS, Tariot PN, Dagerman KS, et al. CATIE-AD Study Group: effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med 2006; 355: 1525-8 CrossRef
  51. Ballard C, Lana MM, Theodoulou M, et al. A randomised blinded placebo controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Med 2008; 5: e76 CrossRef
  52. Tune LE, Steele C, Cooper T. Neuroleptic drugs in the management of behavioral symptoms of Alzheimer’s disease. Psychiatr Clin North Am 1991; 14: 353-3
  53. Reilly JG, Ayis SA, Ferrier IN, et al. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet 2000; 355: 1048-2 CrossRef
  54. Gill SS, Rochon PA, Herrmann N, et al. Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. BMJ 2005; 330: 445 CrossRef
  55. Herrmann N, Mamdani M, Lanctot KL. Atypical antipsychotics and risk of cerebrovascular accidents. Am J Psych 2004; 161: 1113- CrossRef
  56. U.S. Food and Drug Administration. Deaths with antipsychotics in elderly patients with behavioral disturbances: FDA Public Health Advisory. Centre for Drug Evaluation and Research 2005 Jul 13 [online]. Available from URL: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders [Accessed 2010 Jun 25]
  57. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294: 1934-3 CrossRef
  58. Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005; 353: 2335-1 CrossRef
  59. Ballard C, Hanney ML, Theodoulou M, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009; 8: 151- CrossRef
  60. McShane R, Keene J, Gedling K, et al. Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up. BMJ 1997; 314: 266-0 CrossRef
  61. Trinh NH, Hoblyn J, Mohanty S, et al. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis. JAMA 2003; 289: 210- CrossRef
  62. Holmes C, Wilkinson D, Dean C, et al. The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology 2004; 63: 214- CrossRef
  63. Howard RJ, Juszczak E, Ballard CG, et al., CALM-AD Trial Group. Donepezil for the treatment of agitation in Alzheimer’s disease. N Engl J Med 2007; 357: 1382-2 CrossRef
  64. Gauthier S, Feldman H, Hecker J, et al. Efficacy of donepezil on behavioral symptoms in patients with moderate to severe Alzheimer’s disease. Int Psychogeriatr 2002; 14: 389-04 CrossRef
  65. McKeith I, Del Ser T, Spano P, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 2000; 356: 2031- CrossRef
  66. Gauthier S, Loft H, Cummings J. Improvement in behavioural symptoms in patients with moderate to severe Alzheimer’s disease by memantine: a pooled data analysis. Int J Geriatr Psychiatry 2008; 23: 537-5 CrossRef
  67. Wilcock GK, Ballard CG, Cooper JA, et al. Memantine for agitation/aggression and psychosis in moderately severe to severe Alzheimer’s disease: a pooled analysis of 3 studies. J Clin Psychiatry 2008; 69: 341- CrossRef
  68. McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006 Apr 19; (2): CD003154
  69. Reifler BV, Teri L, Raskind M, et al. Double-blind trial of imipramine in Alzheimer’s disease patients with and without depression. Am J Psychiatry 1989; 146: 45-
  70. Petracca G, Teson A, Chemerinski E, et al. A double-blind placebo-controlled study of clomipramine in depressed patients with Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 1996; 8: 270-
  71. Bains J, Birks JS, Dening TD, et al. Antidepressants for treating depression in dementia: Cochrane Dementia and Cognitive Improvement Group. Cochrane Database Syst Rev 2007; (3): CD003944
  72. Lyketsos CG, DelCampo L, Steinberg M, et al. Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry 2003; 60: 737-6 CrossRef
  73. Finkel SI, Mintzer JE, Dysken M, et al. A randomized, placebo-controlled study of the efficacy and safety of sertraline in the treatment of the behavioral manifestations of Alzheimer’s disease in outpatients treated with donepezil. Int J Geriatr Psychiatry 2004; 19: 9-8 CrossRef
  74. Pollock BG, Mulsant BH, Rosen J, et al. Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry 2002; 159: 460- CrossRef
  75. Pollock BG, Mulsant BH, Rosen J, et al. A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatric Psych 2007; 15: 942-2 CrossRef
  76. Sultzer DL, Gray KF, Gunay I, et al. A double-blind comparison of trazodone and haloperidol for treatment of agitation in patients with dementia. Am J Geriatr Psychiatry 1997; 5: 60-
  77. Tariot PN, Erb R, Podgorski CA, et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998; 155: 54-1
  78. Olin JT, Fox LS, Pawluczyk S, et al. A pilot randomized trial of carbamazepine for behavioral symptoms in treatment-resistant outpatients with Alzheimer disease. Am J Geriatr Psychiatry 2001; 9: 400-
  79. Konovalov S, Muralee S, Tampi RR. Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review. Int Psychogeriatr 2008; 20: 293-08 CrossRef
  80. McFarland K, Gorman SA, Price DL, et al. Antipsychotic like activity of pimavanserin, a 5-HT2A inverse agonist, in putative animal models of Alzheimer’s disease. Psychosis poster presented at American Academy of Neurology Annual Conference; 2008 Apr 12-9; Chicago (IL)
  81. Revell S, Friedman JH, Mills R, et al. A double-blind placebo controlled, dose escalation trial of pimavanserin in Parkinson’s disease. Psychosis poster presented at American Academy of Neurology Annual Conference; 2008 Apr 12-9; Chicago (IL)
  82. Teri L, Logsdon RG, Uomoto J, et al. Behavioral treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 1997; 52: 159-6 CrossRef
  
• 作者单位：Prof. Clive Ballard (1)
  Anne Corbett (1)
  
  1. Wolfson Centre for Age-Related Diseases, Guy’s Campus, King’s College London, London, SE1 1UL, UK
  
• ISSN：1179-1934

文摘

Neuropsychiatric symptoms are frequent and troublesome in people with dementia and present a major treatment challenge for clinicians. Most good practice guidelines suggest non-pharmacological treatments as the first-line therapy and there is emerging evidence, including randomized controlled trials, that a variety of psychological and training interventions, including social interaction and person-centred care training, are effective. There is evidence from meta-analyses that some atypical antipsychotic drugs, specifically risperidone and aripiprazole, confer benefit in the treatment of aggression in people with Alzheimer’s disease over a period of up to 12 weeks. However, these benefits have to be considered in the context of significant adverse events, including extrapyramidal symptoms, accelerated cognitive decline, stroke and death. In addition, the limited evidence available does not indicate ongoing treatment benefits over longer periods of therapy. The evidence is limited for other pharmacological treatment approaches, but the best evidence is probably for carbamazepine, memantine and citalopram. There is very limited evidence for any therapies in non-Alzheimer dementias. In conclusion, it is important in most situations to limit the use of antipsychotic medication to short-term treatment (up to 12 weeks) of severe neuropsychiatric symptoms to limit harm. Non-pharmacological therapies offer a viable and effective alternative in many situations. Adequately powered randomized controlled trials for the treatment of clinically significant agitation are urgently needed to explore alternative pharmacological therapies.