Treatment of the Neuropsychiatric Symptoms in Alzheimer's Disease

Abstract

Behavioral symptoms are common in Alzheimer’s disease (AD) and represent a major source of the disease morbidity. Neuropsychiatric disturbances have been associated with more rapid cognitive decline (1), increased caregiver burden (2,3), increases in patient care costs due to earlier institutionalization of the AD patient, greater medication use and more adverse side effects and more extensive institutional staffing needs (4,5). Kaufer and colleagues (6) reported a strong correlation between the amount of neuropsychiatric disturbance as measured by the Neuropsychiatric Inventory (NPI) and the degree of caregiver distress with little relationship between the degree of impairment on the Mini-Mental State Exam (MMSE) (7) and the degree of caregiver distress. In addition, a recent cost analysis showed that AD patients with higher NPI scores (worse psychopathology) had formal costs between $3,162 and $5,919 higher than those with low NPI scores and the total direct costs between $10, 670, and $16,141 higher, depending on the severity of cognitive impairments (8). Clinical research on the treatment of these non-cognitive symptoms has only recently become a subject of major investigation. Clinical drug trials of new therapeutic agents in AD are beginning to regularly include specific scales to measure potential changes in behavioral symptoms with respect to their therapeutic interventions. In addition, an increasing number of randomized, placebo-controlled clinical trials of a wide variety of psychotropic medications to treat significant behavioral disturbances in dementia are beginning to emerge. The successful management of troublesome behaviors associated with AD can significantly improve the overall quality of life for patients and their caregivers and could result in significant relevant benefit.