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Management of behavioral problems in Alzheimer's disease

Published online by Cambridge University Press:  25 January 2010

Serge Gauthier ,
Jeffrey Cummings ,
Clive Ballard ,
Henry Brodaty ,
George Grossberg ,
Philippe Robert  and
Constantine Lyketsos
Serge Gauthier*
Affiliation:
Alzheimer's Disease and Related Disorders Unit at the McGill Center for Studies in Aging, Douglas Mental Health University Institute, Montreal, Canada
Jeffrey Cummings
Affiliation:
Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, California, U.S.A.
Clive Ballard
Affiliation:
Age Related Diseases, King's College London, London, U.K.
Henry Brodaty
Affiliation:
Primary Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia
George Grossberg
Affiliation:
Department of Neurology and Psychiatry, St Louis University School of Medicine, St Louis, Missouri, U.S.A.
Philippe Robert
Affiliation:
Centre Mémoire de Ressources et de Recherche (Memory Centre for Care and Research), CHU de Nice, Hôpital Pasteur, Nice, France
Constantine Lyketsos
Affiliation:
Department of Psychiatry, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.
*
Correspondence should be addressed to: Serge Gauthier, Director of the Alzheimer's Disease and Related Disorders Unit at the McGill Center for Studies in Aging, Douglas Mental Health University Institute, Montreal, Canada. Phone: +1 514 766 2010; Fax: +1 514 888 4050. Email: [email protected].
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Abstract

Alzheimer's disease (AD) is a complex progressive brain degenerative disorder that has effects on multiple cerebral systems. In addition to cognitive and functional decline, diverse behavioral changes manifest with increasing severity over time, presenting significant management challenges for caregivers and health care professionals. Almost all patients with AD are affected by neuropsychiatric symptoms at some point during their illness; in some cases, symptoms occur prior to diagnosis of the dementia syndrome. Further, behavioral factors have been identified, which may have their origins in particular neurobiological processes, and respond to particular management strategies. Improved clarification of causes, triggers, and presentation of neuropsychiatric symptoms will guide both research and clinical decision-making. Measurement of neuropsychiatric symptoms in AD is most commonly by means of the Neuropsychiatric Inventory; its utility and future development are discussed, as are the limitations and difficulties encountered when quantifying behavioral responses in clinical trials. Evidence from clinical trials of both non-pharmacological and pharmacological treatments, and from neurobiological studies, provides a range of management options that can be tailored to individual needs. We suggest that non-pharmacological interventions (including psychosocial/psychological counseling, interpersonal management and environmental management) should be attempted first, followed by the least harmful medication for the shortest time possible. Pharmacological treatment options, such as antipsychotics, antidepressants, anticonvulsants, cholinesterase inhibitors and memantine, need careful consideration of the benefits and limitations of each drug class.

Keywords

behaviorAlzheimer'smeasurementtreatmentnon-pharmacologicpharmacologic
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 3 , May 2010 , pp. 346 - 372
Copyright
Copyright © International Psychogeriatric Association 2010

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