PL EN


Preferences help
enabled [disable] Abstract
Number of results
2012 | 12 | 4 | 236–244
Article title

Zaburzenia psychiczne w przebiegu zespołów otępiennych – znaczenie kliniczne i zasady postępowania

Authors
Content
Title variants
EN
Psychiatric disorders coexisting with dementia – clinical relevance and principles of management
Languages of publication
PL
Abstracts
PL
Zaburzenia psychiczne (psychozy, depresje, zaburzenia lękowe) oraz inne objawy behawioralne i psychologiczne (behavioural and psychological symptoms of dementia, BPSD) są powszechne u chorych z otępieniami, niezależnie od ich domniemanej etiologii. Spotyka się je nawet w fazach prodromalnych otępień, a nasilenie i rozpowszechnienie wielu z nich narasta wraz z progresją dysfunkcji poznawczych. Występowanie BPSD wiąże się z szeregiem negatywnych konsekwencji zarówno dla pacjenta, jak i jego opiekunów. Obecność objawów psychotycznych pogarsza naturalny przebieg demencji, powodując szybsze narastanie deficytów poznawczych, wzrost liczby hospitalizacji oraz ryzyka umieszczenia w placówce opiekuńczej i śmiertelności, większe nasilenie funkcjonalnej niesprawności, jak również jednoznacznie udokumentowane pogorszenie funkcjonowania opiekunów i wzrost ryzyka wystąpienia u nich zaburzeń psychicznych, zwłaszcza depresyjnych. Leczenie BPSD jest trudne, nie opracowano dotąd powszechnie akceptowanego standardu, skutecznego u większości pacjentów. Zaleca się wdrożenie metod niefarmakologicznych praktycznie u wszystkich pacjentów, istotną rolę odgrywa także edukacja opiekunów. Kluczowe dla powodzenia terapii jest optymalne dawkowanie leków prokognitywnych, inhibitorów cholinesterazy i memantyny. Leki psychotropowe mają ograniczoną skuteczność i mogą powodować poważne objawy niepożądane. Szczególnej ostrożności wymaga stosowanie leków przeciwpsychotycznych, które, choć czasami niezbędne, zwiększają ryzyko przedwczesnego zgonu – mogą wywoływać incydenty sercowo-mózgowe. Leki przeciwdepresyjne są relatywnie mało skuteczne w leczeniu depresji i zaburzeń lękowych, natomiast mogą być pomocne w leczeniu pobudzenia, agresji i psychozy, co udokumentowano zwłaszcza w przypadku citalopramu i trazodonu.
EN
Psychiatric disorders (including psychosis, depression and anxiety disorders) as well as other behavioural and psychological symptoms of dementia (collectively referred to as BPSD) are common in the demented, regardless of presumed aetiology of dementia. They may appear even at the prodromal phase of dementia, while severity and incidence of many of them increases with progression of cognitive dysfunction. Development of BPSD is associated with several negative consequences, both for the patient and his/her caregivers. Presence of psychotic symptoms affects unfavourably further course of dementia, accelerating cognitive decline, increased number of hospitalizations, risk of institutionalization and mortality as well as greater degree of functional disability. A well-documented phenomenon correlated therewith isincreased caregivers’ burden and increased risk of caregivers’ psychiatric problems, including depression. Treatment of BPSD is difficult and no uniformly accepted and universally effective management standard or guidelines have been proposed to date. Non-pharmacological approach is considered obligatory for most patients, while education of caregivers or institution personnel is paramount. The key issue is optimal dosage of anti-dementia drugs, including cholinesterase inhibitors and memantine. Efficacy of psychotropic drugs is largely limited and their clinical usefulness compromised by poor side effects profile of many of them. Particular care must be paid when using antipsychotics due to presumed risk of premature death secondary to cerebrovascular complications. Antidepressants, though relatively ineffective in treating depression and anxiety, might be an option in patients with agitation, aggression and psychosis as documented to date in the case of citalopram and trazodone.
Discipline
Year
Volume
12
Issue
4
Pages
236–244
Physical description
Contributors
author
  • Zakład Psychologii Lekarskiej, Uniwersytet Medyczny w Łodzi
References
  • 1. Esquirol J.E.D.: Des maladies mentales considérées sous les rapports médical, hygiénique et médico-légal. Ed. Baillière Jean-Baptiste (et fils), Paris 1838.
  • 2. Alzheimer A.: Über eine eigenartige Erkrankung der Hirnrinde. Allgemeine Zeitschrift für Psychiatrie und psychischgerichtliche Medizin 1907; 64: 146-148.
  • 3. Finkel S.I., Costa e Silva J., Cohen G. i wsp.: Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int. Psychogeriatr. 1996; 8 supl. 3: 497-500.
  • 4. Jeste D.V., Finkel S.I.: Psychosis of Alzheimer’s disease and related dementias. Diagnostic criteria for a distinct syndrome. Am. J. Geriatr. Psychiatry 2000; 8: 29-34.
  • 5. Olin J.T., Schneider L.S., Katz I.R. i wsp.: Provisional diagnostic criteria for depression of Alzheimer disease. Am. J. Geriatr. Psychiatry 2002; 10: 125-128.
  • 6. Lawlor B.A.: Behavioral and psychological symptoms in dementia: the role of atypical antipsychotics. J. Clin. Psychiatry 2004; 65 supl. 11: 5-10.
  • 7. Lyketsos C.G., Steinberg M., Tschanz J.T. i wsp.: Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am. J. Psychiatry 2000; 157: 708-714.
  • 8. Savva G.M., Zaccai J., Matthews F.E. i wsp.; Medical Research Council Cognitive Function and Ageing Study: Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br. J. Psychiatry 2009; 194: 212-219.
  • 9. Di Iulio F., Palmer K., Blundo C. i wsp.: Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer’s disease and mild cognitive impairment subtypes. Int. Psychogeriatr. 2010; 22: 629-640.
  • 10. Monastero R., Mangialasche F., Camarda C. i wsp.: A systematic review of neuropsychiatric symptoms in mild cognitive impairment. J. Alzheimers Dis. 2009; 18: 11-30.
  • 11. Teng E., Lu P.H., Cummings J.L.: Neuropsychiatric symptoms are associated with progression from mild cognitive impairment to Alzheimer’s disease. Dement. Geriatr. Cogn. Disord. 2007; 24: 253-259.
  • 12. Lyketsos C.G., Lopez O., Jones B. i wsp.: Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA 2002; 288: 1475-1483.
  • 13. Benoit M., Staccini P., Brocker P. i wsp.: Behavioral and psychologic symptoms in Alzheimer’s disease: results of the REAL.FR study. Rev. Med. Interne 2003; 24 supl. 3: 319s-324s.
  • 14. Craig D., Mirakhur A., Hart D.J. i wsp.: A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer’s disease. Am. J. Geriatr. Psychiatry 2005; 13: 460-468.
  • 15. Kim J.M., Lyons D., Shin I.S., Yoon J.S.: Differences in the behavioral and psychological symptoms between Alzheimer’s disease and vascular dementia: are the different pharmacologic treatment strategies justifiable? Hum. Psychopharmacol. 2003; 18: 215-220.
  • 16. Fernández-Martínez M., Castro J., Molano A. i wsp.: Prevalence of neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. Curr. Alzheimer Res. 2008; 5: 61-69.
  • 17. Chan M., Lim W.S., Sahadevan S.: Stage-dependent and stage-specific phenotypic differences between vascular dementia and Alzheimer’s disease. Dement. Geriatr. Cogn. Disord. 2008; 26: 513-521.
  • 18. Aarsland D., Cummings J.L., Larsen J.P.: Neuropsychiatric differences between Parkinson’s disease with dementia and Alzheimer’s disease. Int. J. Geriatr. Psychiatry 2001; 16: 184-191.
  • 19. Johnson D.K., Watts A.S., Chapin B.A. i wsp.: Neuropsychiatric profiles in dementia. Alzheimer Dis. Assoc. Disord. 2011; 25: 326-332.
  • 20. Palmer K., Lupo F., Perri R. i wsp.: Predicting disease progression in Alzheimer’s disease: the role of neuropsychiatric syndromes on functional and cognitive decline. J. Alzheimers Dis. 2011; 24: 35-45.
  • 21. Wilson R.S., Krueger K.R., Kamenetsky J.M. i wsp.: Hallucinations and mortality in Alzheimer disease. Am. J. Geriatr. Psychiatry 2005; 13: 984-990.
  • 22. Rosenberg P.B., Mielke M.M., Han D. i wsp.: The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer’s disease. Int. J. Geriatr. Psychiatry 2012; 27: 1248-1257.
  • 23. Rabins P.V., Mace N.L., Lucas M.J.: The impact of dementia on the family. JAMA 1982; 248: 333-335.
  • 24. Herrmann N., Lanctôt K.L., Sambrook R. i wsp.: The contribution of neuropsychiatric symptoms to the cost of dementia care. Int. J. Geriatr. Psychiatry 2006; 21: 972-976.
  • 25. Neil W., Bowie P.: Carer burden in dementia – assessing the impact of behavioural and psychological symptoms via self-report questionnaire. Int. J. Geriatr. Psychiatry 2008; 23: 60-64.
  • 26. Selbaek G., Kirkevold Ø., Engedal K.: The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes – a 12-month follow-up study. Am. J. Geriatr. Psychiatry 2008; 16: 528-536.
  • 27. Wetzels R., Zuidema S., Jansen I. i wsp.: Course of neuropsychiatric symptoms in residents with dementia in longterm care institutions: a systematic review. Int. Psychogeriatr. 2010; 22: 1040-1053.
  • 28. Wetzels R.B., Zuidema S.U., de Jonghe J.F. i wsp.: Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. Am. J. Geriatr. Psychiatry 2010; 18: 1054-1065.
  • 29. Gonfrier S., Andrieu S., Renaud D. i wsp.: Course of neuropsychiatric symptoms during a 4-year follow up in the REAL-FR cohort. J. Nutr. Health Aging 2012; 16: 134-137.
  • 30. Ropacki S.A., Jeste D.V.: Epidemiology of and risk factors for psychosis of Alzheimer’s disease: a review of 55 studies published from 1990 to 2003. Am. J. Psychiatry 2005; 162: 2022-2030.
  • 31. Schneider L.S., Dagerman K.S.: Psychosis of Alzheimer’s disease: clinical characteristics and history. J. Psychiatr. Res. 2004; 38: 105-111.
  • 32. Bassiony M.M., Steinberg M.S., Warren A. i wsp.: Delusions and hallucinations in Alzheimer’s disease: prevalence and clinical correlates. Int. J. Geriatr. Psychiatry 2000; 15: 99-107.
  • 33. DeMichele-Sweet M.A., Sweet R.A.: Genetics of psychosis in Alzheimer’s disease: a review. J. Alzheimers Dis. 2010; 19: 761-780.
  • 34. Flirski M., Sobow T., Kloszewska I.: Behavioural genetics of Alzheimer’s disease: a comprehensive review. Arch. Med. Sci. 2011; 7: 195-210.
  • 35. Ostling S., Gustafson D., Blennow K. i wsp.: Psychotic symptoms in a population-based sample of 85-year-old individuals with dementia. J. Geriatr. Psychiatry Neurol. 2011; 24: 3-8.
  • 36. Weintraub D., Hurtig H.I.: Presentation and management of psychosis in Parkinson’s disease and dementia with Lewy bodies. Am. J. Psychiatry 2007; 164: 1491-1498.
  • 37. Aarsland D., Ballard C., Larsen J.P., McKeith I.: A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson’s disease with and without dementia. Int. J. Geriatr. Psychiatry 2001; 16: 528-536.
  • 38. Ballard C., Holmes C., McKeith I. i wsp.: Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer’s disease. Am. J. Psychiatry 1999; 156: 1039-1045.
  • 39. Solfrizzi V., D’Introno A., Colacicco A.M. i wsp.: Italian Longitudinal Study on Aging Working Group: Incident occurrence of depressive symptoms among patients with mild cognitive impairment – the Italian Longitudinal Study on Aging. Dement. Geriatr. Cogn. Disord. 2007; 24: 55-64.
  • 40. Tsuno N., Homma A.: What is the association between depression and Alzheimer’s disease? Expert Rev. Neurother. 2009; 9: 1667-1676.
  • 41. Forsell Y., Winblad B.: Major depression in a population of demented and nondemented older people: prevalence and correlates. J. Am. Geriatr. Soc. 1998; 46: 27-30.
  • 42. Rubin E.H., Veiel L.L., Kinscherf D.A. i wsp.: Clinically significant depressive symptoms and very mild to mild dementia of the Alzheimer type. Int. J. Geriatr. Psychiatry 2001; 16: 694-701.
  • 43. Sultzer D.L., Levin H.S., Mahler M.E. i wsp.: A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am. J. Psychiatry 1993; 150: 1806-1812.
  • 44. Naarding P., de Koning I., dan Kooten F. i wsp.: Depression in vascular dementia. Int. J. Geriatr. Psychiatry 2003; 18: 325-330.
  • 45. Boyle P.A., Malloy P.F.: Treating apathy in Alzheimer’s disease. Dement. Geriatr. Cogn. Disord. 2004; 17: 91-99.
  • 46. Seignourel P.J., Kunik M.E., Snow L. i wsp.: Anxiety in dementia: a critical review. Clin. Psychol. Rev. 2008; 28: 1071-1082.
  • 47. Teri L., Ferretti L.E., Gibbons L.E. i wsp.: Anxiety of Alzheimer’s disease: prevalence, and comorbidity. J. Gerontol. A Biol. Sci. Med. Sci. 1999; 54: M348-M352.
  • 48. Gibbons L.E., Teri L., Logsdon R. i wsp.: Anxiety symptoms as predictors of nursing home placement in patients with Alzheimer’s disease. Journal of Clinical Geropsychology 2002; 8: 335-342.
  • 49. Starkstein S.E., Jorge R., Petracca G., Robinson R.G.: The construct of generalized anxiety disorder in Alzheimer disease. Am. J. Geriatr. Psychiatry 2007; 15: 42-49.
  • 50. Robins Wahlin T.B., Byrne G.J.: Personality changes in Alzheimer’s disease: a systematic review. Int. J. Geriatr. Psychiatry 2011; 26: 1019-1029.
  • 51. Chow T.W.: Personality in frontal lobe disorders. Curr. Psychiatry Rep. 2000; 2: 446-451.
  • 52. von Gunten A., Pocnet C., Rossier J.: The impact of personality characteristics on the clinical expression in neurodegenerative disorders – a review. Brain Res. Bull. 2009; 80: 179-191.
  • 53. International Psychogeriatric Association: Behavioral and Psychological Symptoms of Dementia (BPSD): Educational Pack. IPA, 1998, 2002. Adres: www.ipa-online.net/ pdfs/1BPSDfinal.pdf.
  • 54. Tampi R.R., Williamson D., Muralee S. i wsp.: Behavioral and psychological symptoms of dementia: Part II – Treatment. Clin. Geriatr. 2011; 19: 31-40.
  • 55. Verkaik R., van Weert J.C., Francke A.L.: The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review. Int. J. Geriatr. Psychiatry 2005; 20: 301-314.
  • 56. Livingston G., Johnston K., Katona C. i wsp.: Old Age Task Force of the World Federation of Biological Psychiatry: Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am. J. Psychiatry 2005; 162: 1996-2021.
  • 57. Campbell N., Ayub A., Boustani M.A. i wsp.: Impact of cholinesterase inhibitors on behavioral and psychological symptoms of Alzheimer’s disease: a meta-analysis. Clin. Interv. Aging 2008; 3: 719-728.
  • 58. Rodda J., Morgan S., Walker Z.: Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer’s disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. Int. Psychogeriatr. 2009; 21: 813-824.
  • 59. Rolinski M., Fox C., Maidment I., McShane R.: Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson’s disease dementia and cognitive impairment in Parkinson’s disease. Cochrane Database Syst. Rev. 2012; 3: CD006504.
  • 60. O’Brien J.T., Burns A.: BAP Dementia Consensus Group: Clinical practice with anti-dementia drugs: a revised (second) consensus statement from the British Association for Psychopharmacology. J. Psychopharmacol. 2011; 25: 997-1019.
  • 61. 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: 537-545.
  • 62. Wilcock G.K., Ballard C.G., Cooper J.A., Loft H.: 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: 341-348.
  • 63. Emre M., Tsolaki M., Bonuccelli U. i wsp.: 11018 Study Investigators: Memantine for patients with Parkinson’s disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2010; 9: 969-977.
  • 64. Sink K.M., Holden K.F., Yaffe K.: Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293: 596-608.
  • 65. Yury C.A., Fisher J.E.: Meta-analysis of the effectiveness of atypical antipsychotics for the treatment of behavioural problems in persons with dementia. Psychother. Psychosom. 2007; 76: 213-218.
  • 66. Maher A.R., Maglione M., Bagley S. i wsp.: Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA 2011; 306: 1359-1369.
  • 67. Mazzucco S., Cipriani A., Barbui C., Monaco S.: Antipsychotic drugs and cerebrovascular events in elderly patients with dementia: a systematic review. Mini Rev. Med. Chem. 2008; 8: 776-783.
  • 68. Schneider L.S., Pollock V.E., Lyness S.A.: A metaanalysis of controlled trials of neuroleptic treatment in dementia. J. Am. Geriatr. Soc. 1990; 38: 553-563.
  • 69. Wang P.S., Schneeweiss S., Avorn J. i wsp.: Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N. Engl. J. Med. 2005; 353: 2335-2341.
  • 70. Gill S.S., Bronskill S.E., Normand S.L. i wsp.: Antipsychotic drug use and mortality in older adults with dementia. Ann. Intern. Med. 2007; 146: 775-786.
  • 71. Angelini A., Bendini C., Neviani F., Neri M.: Behavioral and psychological symptoms of dementia (BPSD) in elderly demented subjects: is the long lasting use of atypical antipsychotic drugs useful and safe? Arch. Gerontol. Geriatr. 2007; 44 supl. 1: 35-43.
  • 72. Nelson J.C., Devanand D.P.: A systematic review and metaanalysis of placebo-controlled antidepressant studies in people with depression and dementia. J. Am. Geriatr. Soc. 2011; 59: 577-585.
  • 73.Henry G., Williamson D., Tampi R.R.: Efficacy and tolerability of antidepressants in the treatment of behavioral and psychological symptoms of dementia, a literature review of evidence. Am. J. Alzheimers Dis. Other Demen. 2011; 26: 169-183
  • 74. Seitz D.P., Adunuri N., Gill S.S. i wsp.: Antidepressants for agitation and psychosis in dementia. Cochrane Database Syst. Rev. 2011; (2): CD008191.
  • 75. Konovalov S., Muralee S., Tampi R.R.: Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review. Int. Psychogeriatr. 2008; 20: 293-308.
  • 76. Yeh Y.C., Ouyang W.C.: Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: an update review. Kaohsiung J. Med. Sci. 2012; 28: 185-193.
  • 77. Chase T.N.: Apathy in neuropsychiatric disease: diagnosis, pathophysiology, and treatment. Neurotox. Res. 2011; 19: 266-278.
  • 78. Pahwa R., Stacy M.A., Factor S.A. i wsp.: EASE-PD Adjunct Study Investigators: Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease. Neurology 2007; 68: 1108-1115.
Document Type
article
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.psjd-5d641e61-8558-445c-8635-7103b2b4b38e
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.