Treatment of noncognitive neuropsychiatric disorders in Alzheimer's disease
https://doi.org/10.14412/2074-2711-2021-6-132-138
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disease, which is caused by cerebral amyloidosis. Noncognitive neuropsychiatric disorders (NСNPDs) include emotional, behavioral disorders, as well as psychotic symptoms. NСNPDs are almost an obligatory manifestation of this disease, accompany cognitive impairment and are detected at all stages of the disease – from preclinical to the severe dementia stage. As an example, we present a case report of a female patient with mild dementia in AD in whom Akatinol memantine administration resulted in the stabilization of a cognitive defect within one year and a decrease in the severity of emotional and behavioral disorders. The article discusses the indications and contraindications for antipsychotic administration in this disease, NСNPDs treatment in AD, which includes nonpharmacological and pharmacological methods. Accurate analysis of NСNPDs allows to predict the disease course, optimize the treatment, and thereby improve the quality of life of the patient and his relatives and caregivers.
Keywords
Alzheimer’s disease,
cognitive impairment,
noncognitive neuropsychiatric disorders,
dementia,
akatinol memantine,
benzodiazepines,
antipsychotic drugs.
Supporting agencies: This article has been supported by «Merz».
About the Authors
A. B. Lokshina
N.V. Sklifosovsky Institut of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
Russian Federation
Department of Nervous System Diseases and Neurosurgery
11, Rossolimo St., Build. 1, Moscow 119021, Russia
D. A. Grishina
N.V. Sklifosovsky Institut of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
Russian Federation
Department of Nervous System Diseases and Neurosurgery
11, Rossolimo St., Build. 1, Moscow 119021, Russia
References
1. Parfenov VA, Zaharov VV, Preobrazenskaya IS. Kognitivnyye rasstroystva [Cognitive impairment]. Moscow; 2014. 192 p. (In Russ.).
2. Yakhno NN, Zakharov VV, Lokshina AB, et al. Dementsii: Rukovodstvo dlya vrachey [Dementia. Guidance for doctors]. Moscow: Medpressinform; 2011. P. 17-28. Available from: https://www.03book.ru/upload/iblock/987/415_Demencija_Jahno.pdf (accessed 24.02.2021) (In Russ.).
3. Parfenov VA. Alzheimer’s disease: clinical management errors. Meditsinskiy sovet = Medical Council. 2020;(19):23-8. doi: 10.21518/2079-701X-2020-19-23-28 (In Russ.).
4. 2016 Alzheimer's disease facts and figures. Alzheimer's Association. Alzheimers Dement. 2016;12(4):459-509. doi: 10.1016/j.jalz.2016.03.001
5. Germain S, Adam S, Olivier C, et al. Does cognitive impairment influence burden in caregivers of patients with Alzheimer's disease? J Alzheimers Dis. 2009;17(1):105-14. doi: 10.3233/JAD-2009-1016
6. Eikelboom WS, van den Berg E, Singleton EH, et al. Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations. Neurology. 2021 Sep 28;97(13):e1276-e1287. doi: 10.1212/WNL.0000000000012598. Epub 2021 Aug 19.
7. Zhao QF, Tan L, Wang HF, et al. The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis. J Affect Disord. 2016 Jan 15;190:264-71. doi: 10.1016/j.jad.2015.09.069. Epub 2015 Oct 24.
8. Chen Y, Dang M, Zhang Z. Brain mechanisms underlying neuropsychiatric symptoms in Alzheimer's disease: a systematic review of symptom-general and -specific lesion patterns. Mol Neurodegener. 2021 Jun 7;16(1):38. doi: 10.1186/s13024-021-00456-1
9. Murman DL, Chen Q, Powell MC, et al. The incremental direct costs associated with behavioral symptoms in AD. Neurology. 2002 Dec 10;59(11):1721-9. doi: 10.1212/01.wnl.0000036904.73393.e4
10. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimers Dement. 2011 May;7(3):263-9. doi: 10.1016/j.jalz.2011.03.005. Epub 2011 Apr 21.
11. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging – Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):270-9. doi: 10.1016/j.jalz.2011.03.008. Epub 2011 Apr 21.
12. Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimers Dement. 2011 May;7(3):280-92. doi: 10.1016/j.jalz.2011.03.003. Epub 2011 Apr 21.
13. Jack CR Jr, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on AgingAlzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011 May;7(3):257-62. doi: 10.1016/j.jalz.2011.03.004. Epub 2011 Apr 21.
14. Apostolova LG, Cummings JL. Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dement Geriatr Cogn Disord. 2008;25(2):115-26. doi: 10.1159/000112509. Epub 2007 Dec 14.
15. Wiels WA, Wittens MMJ, Zeeuws D, et al. Neuropsychiatric Symptoms in Mild Cognitive Impairment and Dementia Due to AD: Relation With Disease Stage and Cognitive Deficits. Front Psychiatry. 2021 Aug 17;12:707580. doi: 10.3389/fpsyt.2021.707580. eCollection 2021.
16. Moran M, Walsh C, Lynch A, et al. Syndromes of behavioural and psychological symptoms in mild Alzheimer's disease. Int J Geriatr Psychiatry. 2004 Apr;19(4):359-64. doi: 10.1002/gps.1091
17. Defrancesco M, Marksteiner J, Kemmler G, et al. Specific Neuropsychiatric Symptoms Are Associated with Faster Progression in Alzheimer's Disease: Results of the Prospective Dementia Registry (PRODEMAustria). J Alzheimers Dis. 2020;73(1):125-33. doi: 10.3233/JAD-190662
18. Voznesenskaya TG, Medvedeva AV, Yakhno NN. Non-cognitive neuropsychiatric disorders in Alzheimer's disease and it’s correction. Nevrologicheskiy zhurnal. 2010;15(4):18-24 (In Russ.).
19. Rosenberg PB, Nowrangi MA, Lyketsos CG. Neuropsychiatric symptoms in Alzheimer's disease: What might be associated brain circuits? Mol Aspects Med. Jun-Oct 2015;43-44:25-37. doi: 10.1016/j.mam.2015.05.005. Epub 2015 Jun 3.
20. Kales H, Gitlin L, Lyketsos C. Assessmentand management of behavioral and psychological symptoms of dementia. BMJ. 2015 Mar 2;350:h369. doi: 10.1136/bmj.h369
21. Senanarong V, Cummings JL, Fairbanks L, et al. Agitation in Alzheimer's disease is a manifestation of frontal lobe dysfunction. Dement Geriatr Cogn Disord. 2004;17(1-2):14-20. doi: 10.1159/000074080. Epub 2003 Oct 13.
22. Zakharov VV, Voznesenskaya TG. Neuropsychiatric disorders: diagnostic tests. Moscow: Medpress-inform; 2018. 320 p. Available from: https://static-ru.insales.ru/files/1/4942/10457934/original/nervno_psix_nar.pdf (accessed 24.02.2021) (In Russ.).
23. Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994 Dec;44(12):2308-14. doi: 10.1212/wnl.44.12.2308
24. Vasenina EE, Gan’kina OA. Neuropsychiatric disorders in dementia: mechanisms and treatment approach. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2017;6(2):58-65. doi: 10.17116/jnevro20171176258-65 (In Russ.).
25. Chalfont G, Milligan C, Simpson J. A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia. Dementia (London). 2020 May;19(4):1086-130. doi: 10.1177/1471301218795289. Epub 2018 Sep 7.
26. Kales H, Kim H, Zivin K, et al. Risk of mortality among individual antipsychotics in patients with dementia. Am J Psychiatry. 2012 Jan;169(1):71-9. doi: 10.1176/appi.ajp.2011.11030347. Epub 2011 Oct 31.
27. Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia. Am J Psychiatry. 2016;173(5):543-6. doi: 10.1176/appi.ajp.2015.173501
28. Ettcheto M, Olloquequi J, Sanchez-Lopez E, et al. Benzodiazepines and Related Drugs as a Risk Factor in Alzheimer’s Disease Dementia. Front Aging Neurosci. 2020 Jan 8;11:344. doi: 10.3389/fnagi.2019.00344. eCollection 2019.
29. Suzuki Y, Sakakibara M, Shiraishi N, et al. Use of Anti-Dementia Drugs Reduces the Risk of Potentially Inappropriate Medications: A Secondary Analysis of a Nationwide Survey of Prescribing Pharmacies. Dement Geriatr Cogn Disord. 2020;49(5):526-32. doi: 10.1159/000512043. Epub 2020 Dec 4.
30. Kolykhalov IV. Treatment of behavioral and psychotic symptoms of Alzheimer’s disease: the contribution of memantine. Sovremennaya terapiya v psikhiatrii i nevrologii. 2013;(3-4):17-20 (In Russ.).
31. Francis PT. Altered Glutamate Neurotransmission and Behaviour in Dementia: Evidence from Studies of Memantine. Current Mol Pharmacol. 2009 Jan;2(1):77-82. doi: 10.2174/1874467210902010077
32. McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev. 2019 Mar 20;3(3):CD003154. doi: 10.1002/14651858.CD003154.pub
33. Tekin S, Mega MS, Masterman DM, et al. Orbitofrontal and anterior cingulate cortex neurofibrillary tangle burden is associated with agitation in Alzheimer disease. Ann Neurol. 2001 Mar;49(3):355-61.
34. Reisberg B, Doody R, Stöffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003 Apr 3;348(14):1333-41. doi: 10.1056/NEJMoa013128
35. Cummings JL, Schneider E, Tariot PN, Graham SM. Behavioral effects of memantine in Alzheimer disease patients receiving donepezil treatment. Neurology. 2006 Jul 11;67(1):57-63. doi: 10.1212/01.wnl.0000223333.42368.f1
36. 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 Geriatric Psych. 2008 May;23(5):537-45. doi: 10.1002/gps.1949
37. Kishi T, Matsunaga S, Iwata N. The effects of memantine on behavioral disturbances in patients with Alzheimer's disease: a meta-analysis. Neuropsychiatr Dis Treat. 2017 Jul 20;13:1909-28. doi: 10.2147/NDT.S142839. eCollection 2017.
38. Preobrazhenskaya IS. NMDA receptor antagonists in the treatment of neurological diseases. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):71-7. doi: 10.14412/2074-2711-2020-5-71-77 (In Russ.).
39. Folch J, Busquets O, Ettcheto M, et al. Memantine for the Treatment of Dementia: A Review on its Current and Future Applications. J Alzheimers Dis. 2018;62(3):1223-40. doi: 10.3233/JAD-170672
Review
For citations:
Lokshina AB, Grishina DA. Treatment of noncognitive neuropsychiatric disorders in Alzheimer's disease. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(6):132-138. (In Russ.) https://doi.org/10.14412/2074-2711-2021-6-132-138
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