Neuropsychiatric symptoms in mayor neurocognitive disorder: A narrative review
PDF (Español)
XML (Español)

Keywords

dementia
cognitive dysfunction
affective symptoms
behavioral symptoms
neuropsychiatric symptoms

Abstract

Introduction: Neuropsychiatric symptoms are behavioral and psychological manifestations present in patients with neurocognitive disorder. They have high prevalence and are associated with negative outcomes such as decreased quality of life for both patients and their caregivers, higher rates of institutionalization, and disease progression, which is their reason for having clinical significance. This narrative review aims to provide an update on neuropsychiatric symptoms in major neurocognitive disorder.

Methods: A literature search was conducted in the following databases: MEDLINE (PubMed), EMBASE, LiLACS, and SciELO. The most relevant information was selected for the construction of this review.

Results: The review emphasized the definition, characterization, diagnostic strategies, and treatment approaches for neuropsychiatric symptoms in major neurocognitive disorder, with the goal of providing useful information for the clinical practice of various health professionals.

Discussions: The results of this review highlight the importance of early diagnosis of neuropsychiatric symptoms and the personalized approach to each of them through a proposed algorithm that involves general and pharmacological measures

Conclusion: Neuropsychiatric symptoms are manifestations of major neurocognitive disorder and can cause a significant burden of illness for individuals and their caregivers. Therefore, it is important to detect and treat them with individualized strategies to improve the quality of life for patients.

https://doi.org/10.22379/anc.v41i4.1906

PDF (Español)
XML (Español)

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. [Manual diagnóstico y estadístico de los trastornos mentales]. 5.ª edición. Arlington: American Psychiatric Publishing; 2013. https://doi.org/10.1176/appi.books.9780890425596

Ramos Martín-Vegue AJ. Clasificación internacional de enfermedades CIE-10-ES: solo sombras en su implantación. Rev Calid Asist. 2017;32(1):6-9. https://doi.org/10.1016/j.cali.2016.12.002

Santacruz Escudero JM, Beltrán J, Palacios Á, Chimbí CM, Matallana D, Reyes P, et al. Neuropsychiatric symptoms as predictors of clinical course in neurodegeneration: a longitudinal study. Front Aging Neurosci. 2019;11:176. https://doi.org/10.3389/fnagi.2019.00176

García-Martín V, de Hoyos-Alonso MC, Ariza-Cardiel G, Delgado-Puebla R, García-Domingo P, Hernández-Melo E, et al. Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study. BMC Geriatr. 2022;22(1):71. https://doi.org/10.1186/s12877-022-02762-9

Ming Liew T. Symptom clusters of neuropsychiatric symptoms in mild cognitive impairment and their comparative risks of dementia: a cohort study of 8530 older persons. J Am Med Dir Assoc. 2019;20(8):1054.e1-9. https://doi.org/10.1016/j.jamda.2019.02.012

Mortby ME, Burns R, Eramudugolla R, Ismail Z, Anstey KJ. Neuropsychiatric symptoms and cognitive impairment: understanding the importance of co-morbid symptoms. J Alzheimers Dis. 2017;59(1):141-53. https://doi.org/10.3233/jad-170050

Altomari N, Bruno F, Laganà V, Smirne N, Colao R, Curcio S, et al. A comparison of behavioral and psychological symptoms of dementia (BPSD) and BPSD sub-syndromes in early-onset and late-onset Alzheimer’s disease. J Alzheimers Dis. 2022;85(2):691-9. https://doi.org/10.3233/jad-215061

Botero-Rodríguez F, Córdoba Sastoque AM, Santacruz Escudero JM, Santamaría-García H. Neuropsychiatric symptoms in patients with neurocognitive disorder and their performance between mild and major stages. J Alzheimers Dis. 2022;85(4):1735-44. https://doi.org/10.3233/jad-215283

Ford AH. Neuropsychiatric aspects of dementia. Maturitas. 2014;79(2):209-15. https://doi.org/10.1016/j.maturitas.2014.04.005

Chimbí-Arias C, Santacruz-Escudero JM, Chavarro-Carvajal DA, Samper-Ternent R, Santamaría-García H. Behavioural disturbances in patients with diagnosis of neurocognitive disorder in Bogotá (Colombia). Rev Colomb Psiquiatr. 2020;49(3):136-41. https://doi.org/10.1016/j.rcp.2018.10.007

Cho E, Kim S, Heo SJ, Shin J, Hwang S, Kwon E, et al. Machine learning-based predictive models for the occurrence of behavioral and psychological symptoms of dementia: model development and validation. Sci Rep. 2023;13(1):8073. https://doi.org/10.1038/s41598-023-35194-5

Deví Bastida J, Jodas Clemente L, Jofre Font S, Arroyo Cardona E. Premorbid personality as a risk factor in the appearance of psychological and behavioural symptoms of dementia: systematic review. Rev Esp Geriatr Gerontol. 2019;54(3):168-80. https://doi.org/10.1016/j.regg.2018.08.006

Bankole A, Anderson MS, Homdee N, Alam R, Lofton A, Fyffe N, et al. BESI: Behavioral and environmental sensing and intervention for dementia caregiver empowerment—Phases 1 and 2. Am J Alzheimers Dis Other Demen. 2020;35:1533317520906686. https://doi.org/10.1177/1533317520906686

Cations M, Atee M, Morris T, Whiting D. Neuropsychiatric symptoms of dementia in those with and without a recorded history of psychological trauma: a comparative study from an Australian dementia support service. Int J Geriatr Psychiatry. 2024;39(1):e6054. https://doi.org/10.1002/gps.6054

Steck N, Cooper C, Orgeta V. Investigation of possible risk factors for depression in Alzheimer’s disease: a systematic review of the evidence. J Affect Disord. 2018;236:149-56. https://doi.org/10.1016/j.jad.2018.04.034

Aalten P, Verhey FRJ, Boziki M, Bullock R, Byrne EJ, Camus V, et al. Neuropsychiatric syndromes in dementia. Results from the European Alzheimer Disease Consortium: part I. Dement Geriatr Cogn Disord. 2007;24(6):457-63. https://doi.org/10.1159/000110738

Teixeira AL, Pessoa Rocha N, Gatchel J. Behavioral or neuropsychiatric symptoms of Alzheimer’s disease: from psychopathology to pharmacological management. Arq Neuropsiquiatr. 2023;81(12):1152-62. https://doi.org/10.1055/s-0043-1777774

Gerlach LB, Kales HC. Managing behavioral and psychological symptoms of dementia. Clin Geriatr Med. 2020;36(2):315-27. https://doi.org/10.1016/j.cger.2019.11.010

Ismail Z, Agüera-Ortiz L, Brodaty H, Cieslak A, Cummings J, Fischer CE, et al. The Mild Behavioral Impairment Checklist (MBI-C): a rating scale for neuropsychiatric symptoms in pre-dementia populations. J Alzheimers Dis. 2017;56(3):929-38. https://doi.org/10.3233/jad-160979

Cummings J. The neuropsychiatric inventory: development and applications. J Geriatr Psychiatry Neurol. 2020;33(2):73-84. https://doi.org/10.1177/0891988719882102

Ismail Z, Smith EE, Geda Y, Sultzer D, Brodaty H, Smith G, et al. Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement. 2016;12(2):195-202. https://doi.org/10.1016/j.jalz.2015.05.017

Botero-Rodríguez F, López Figueroa C, Moreno-Contreras J. Evaluación de síntomas neuropsiquiátricos para la detección temprana de trastorno neurocognoscitivo. Acta Neurol Colomb. 2023;39(1):e888. https://doi.org/10.22379/anc.v39i1.888

Howell T. The Wisconsin Star Method: understanding and addressing complexity in geriatrics. En: Malone ML, Boltz M, Macias Tejada J, White H, editores. Geriatrics Models of Care. Cham: Springer International Publishing; 2015. p. 87-94. http://doi.org/10.1007/978-3-319-16068-9_7

Kales HC, Gitlin LN, Lyketsos CG, Detroit Expert Panel on Assessment and Management of Neuropsychiatric Symptoms of Dementia. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014;62(4):762-9. https://doi.org/10.1111/jgs.12730

Hsu TJ, Tsai HT, Hwang AC, Chen LY, Chen LK. Predictors of non-pharmacological intervention effect on cognitive function and behavioral and psychological symptoms of older people with dementia. Geriatr Gerontol Int. 2017;17:28-35. http://doi.org/10.1111/ggi.13037

Marín-Medina DS, Camacho-Gomez OL, Escobedo-Martínez JA, Jaramillo-Toro C, Sánchez-Duque JA. Deprescribing in the elderly with dementia. Acta Neurol Colomb. 2024;40(2). https://doi.org/10.22379/anc.v40i2.1829

Aleixo MAR, Santos RL, do Nascimento Dourado MC. Eficácia da musicoterapia nos sintomas neuropsiquiátricos da demência: revisão sistemática. J Bras Psiquiatr. 2017;66(1):52-61. https://doi.org/10.1590/0047-2085000000150

Cummings J, Sano M, Auer S, Bergh S, Fischer CE, Gerritsen D, et al. Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm. Int Psychogeriatr. 2024;36(4):251-62. https://doi.org/10.1017/s104161022200103x

Ehrhardt S, Porsteinsson AP, Munro CA, Rosenberg PB, Pollock BG, Devanand DP, et al. Escitalopram for agitation in Alzheimer’s disease (S?CitAD): methods and design of an investigator?initiated, randomized, controlled, multicenter clinical trial. Alzheimers Dement. 2019;15(11):1427-36. https://doi.org/10.1016/j.jalz.2019.06.4946

Mühlbauer V, Möhler R, Dichter MN, Zuidema SU, Köpke S, Luijendijk HJ. Antipsychotics for agitation and psychosis in people with Alzheimer’s disease and vascular dementia. Cochrane Database Syst Rev. 2021;12(12):CD013304. https://doi.org/10.1002/14651858.cd013304.pub2

Koenig AM, Arnold SE, Streim JE. Agitation and irritability in Alzheimer’s disease: evidence-based treatments and the black-box warning. Curr Psychiatry Rep. 2016;18(1):3. https://doi.org/10.1007/s11920-015-0640-7

Spalletta G, Caltagirone C, Padovani A, Sorbi S, Attar M, Colombo D, et al. Cognitive and affective changes in mild to moderate Alzheimer’s disease patients undergoing switch of cholinesterase inhibitors: a 6-month observational study. PLoS One. 2014;9(2):e89216. https://doi.org/10.1371/journal.pone.0089216

Kyle K, Bronstein JM. Treatment of psychosis in Parkinson’s disease and dementia with Lewy bodies: a review. Parkinsonism Relat Disord. 2020;75:55-62. https://doi.org/10.1016/j.parkreldis.2020.05.026

Sartorio Menegardo C, Alencar Friggi F, Baldon Scardini J, Souza Rossi T, Dos Santos Vieira T, Tieppo A, et al. Sundown syndrome in patients with Alzheimer’s disease dementia. Dement Neuropsychol. 2019;13(4):469-74. https://doi.org/10.1590/1980-57642018dn13-040015

Kopf D. Massage and touch-based therapy: clinical evidence, neurobiology and applications in older patients with psychiatric symptoms. Z Gerontol Geriatr. 2021;54(8):753-8. https://doi.org/10.1007/s00391-021-01995-4

Wennberg A, Wu M, Rosenberg P, Spira A. Sleep disturbance, cognitive decline, and dementia: a review. Semin Neurol. 2017;37(4):395-406. https://doi.org/10.1055/s-0037-1604351

Rocca P, Marino F, Montemagni C, Perrone D, Bogetto F. Risperidone, olanzapine and quetiapine in the treatment of behavioral and psychological symptoms in patients with Alzheimer’s disease: preliminary findings from a naturalistic, retrospective study. Psychiatry Clin Neurosci. 2007;61(6):622-9. https://doi.org/10.1111/j.1440-1819.2007.01729.x

Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, et al. Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis. BMJ. 2021;372:n532. https://doi.org/10.1136/bmj.n532

van der Steen JT, van Soest-Poorvliet MC, van der Wouden JC, Bruinsma MS, Scholten RJPM, Vink AC. Music-based therapeutic interventions for people with dementia. Cochrane Database Syst Rev. 2017;5(5):CD003477. https://doi.org/10.1002/14651858.cd003477.pub3

Dudas R, Malouf R, McCleery J, Dening T. Antidepressants for treating depression in dementia. Cochrane Database Syst Rev. 2018;8(8):CD003944. https://doi.org/10.1002/14651858.cd003944.pub2

Nimmons D, Aker N, Burnand A, Jordan KP, Cooper C, Davies N, et al. Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2024;157:105507. https://doi.org/10.1016/j.neubiorev.2023.105507

Dolphin H, Dyer AH, McHale C, O'Dowd S, Kennelly SP. An update on apathy in Alzheimer’s disease. Geriatrics. 2023;8(4):75. https://doi.org/10.3390/geriatrics8040075

Teixeira AL, Gonzales MM, Cruz De Souza L, Weisenbach SL. Revisiting apathy in Alzheimer’s disease: from conceptualization to therapeutic approaches. Behav Neurol. 2021:6319826. https://doi.org/10.1155/2021/6319826

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Downloads

Download data is not yet available.