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Published Online: 3 August 2022

Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management

Publication: American Journal of Psychiatry

Abstract

Neuropsychiatric symptoms of dementia (NPS) are a group of noncognitive symptoms that occur in over 90% of individuals with dementia. NPS seem to result from a complex interaction among various biological, psychosocial, and environmental factors, and they are associated with greater morbidity and mortality, higher caregiver burden and burnout, high risk of nursing home placement, and increased cost of care for patients with dementia. Use of standardized assessment tools like the Neuropsychiatric Inventory can assist with qualifying and quantifying NPS. In this review, the authors evaluate the evidence for efficacy and safety of nonpharmacological and pharmacological interventions for treating NPS, mostly based on published meta-analyses. Commonly prescribed medications include atypical antipsychotics, acetylcholinesterase inhibitors, memantine, antidepressants, and mood stabilizers. There are also limited data on cannabinoids, repetitive transcranial magnetic stimulation, and ECT in individuals with NPS. Available evidence indicates that several nonpharmacological interventions are beneficial in the management of NPS and are recommended as first-line treatments. Pharmacotherapy should be reserved for the treatment of more severe or refractory NPS or where nonpharmacological management is not feasible. Atypical antipsychotics have shown mostly modest benefit in reducing NPS, and their use is limited by their adverse effect profiles. Recent investigations suggest potential strategies for preventing or at least reducing the risk of dementia and NPS. The authors conclude with brief guidelines for clinical practice as well as future research.

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Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 528 - 543

History

Accepted: 9 June 2022
Published in print: August 2022
Published online: 3 August 2022

Keywords

  1. Dementia
  2. Psychosis
  3. Agitation
  4. Antipsychotics
  5. Pimavanserin
  6. Schizophrenia Spectrum and Other Psychotic Disorders

Authors

Details

Rajesh R. Tampi, M.D., M.S.
Department of Psychiatry, Creighton University School of Medicine, Omaha (Tampi); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Tampi); Department of Psychiatry, Department of Neurosciences, and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego (Jeste).
Dilip V. Jeste, M.D. [email protected]
Department of Psychiatry, Creighton University School of Medicine, Omaha (Tampi); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Tampi); Department of Psychiatry, Department of Neurosciences, and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego (Jeste).

Notes

Send correspondence to Dr. Jeste ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Supported in part by the Sam and Rose Stein Institute for Research on Aging at University of California San Diego.

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