Affektive und Verhaltensstörungen bei Demenz

O. Schulte-Herbrüggen; I. Heuser

doi:10.1055/s-0038-1626912

Nervenheilkunde, Table of Contents

Nervenheilkunde 2007; 26(08): 663-669
DOI: 10.1055/s-0038-1626912

Kompetenznetz — Demenzen

Schattauer GmbH

Affektive und Verhaltensstörungen bei Demenz

Diagnose und BehandlungAffective and behavioral disorders in dementiaDiagnosis and treatment

O. Schulte-Herbrüggen

¹Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin (Direktorin: Prof. Dr. I. Heuser)

,

I. Heuser

¹Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin (Direktorin: Prof. Dr. I. Heuser)

› Author Affiliations

Abstract

Zusammenfassung

Verhaltensstörungen und affektive Symptome bei Demenzpatienten stellen aufgrund ihrer Häufigkeit eine besondere therapeutische und sozioökonomische Herausforderung dar. In den letzten Jahren konnte insbesondere im Rahmen von metaanalytischen Erhebungen zunehmend Evidenz für wirksame medikamentöse und nicht-medikamentöse Therapien dieser Symptome erarbeitet werden. Dabei limitiert aber die neuronale Vorschädigung bei Demenz erheblich die Dosierungsmöglichkeiten und macht wegen rascher und schwerer auftretenden Nebenwirkungen die häufige Überprüfung von Indikation und Nutzen nötig. Der Artikel gibt einen Überblick zum Kenntnisstand der verschiedenen Interventionsstrategien.

Summary

Behavioural disorders and affective symptoms in dementia constitutea common therapeutic and socio-economic challenge. Recent meta-analyses addressing these problems provide evidence for effective pharmacological and nonpharmacological strategies. Due to dementia-associated neuronal damage pharmacological interventions often cause major side effects that demanda frequent assessment of indication and benefits of the psychopharmacological drugs used in these patients. This article summarizes the current knowledge of different therapeutic interventions.

Schlüsselwörter

Demenz - Verhaltensstörungen - Depression - Aggression - Antidementiva - Neuroleptika

Keywords

Dementia - behavioral and psychological symptoms (BPSD) - depression - aggression - antidementia drugs - neuroleptics

Full Text

References

Literatur
1 Alessi CA, Yoon EJ, Schnelle JF, Al-Samarrai NR, Cruise PA. A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve?. J Am Geriatr Soc 1999; 47: 784-791.
2 Areosa SA, Sherriff F, McShane R. Memantine for dementia. Cochrane Database Syst Rev 2005; CD003154.
3 Ballard C, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev 2006; CD003476.
4 Birks JS, Harvey R. Donepezil for dementia due to Alzheimer’s disease. aCochrane Database Syst Rev 2003; CD001190.
5 Bjork JM, Moeller FG, Kramer GL, Kram M, Suris A, Rush AJ, Petty F. Plasma GABA levels correlate with aggressiveness in relatives of patients with unipolar depressive disorder. Psychiatry Res 2001; 101: 131-136.
6 Buhr GT, White HK. Difficult behaviors in longterm care patients with dementia. J Am Med Dir Assoc 2006; 07: 180-192.
7 Burgener SC, Barton D. Nursing care of cognitively impaired, institutionalized elderly. J Gerontol Nurs 1991; 17: 37-43.
8 Cheston R, Jones K, Gilliard J. Group psychotherapy and people with dementia. Aging Ment Health 2003; 07: 452-461.
9 Cohen CA, Gold DP, Shulman KI, Wortley JT, McDonald G, Wargon M. Factors determining the decision to institutionalize dementing individuals: a prospective study. Gerontologist 1993; 33: 714-720.
10 Cummings JL. Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. Am J Geriatr Psychiatry 2003; 11: 131-145.
11 Danysz W, Parsons CG, Bresink I, Quack G. Glutamate in CNS disorders. Drug News & Perspectives 1995; 08: 261-277.
12 Erkinjuntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Damaraju CV. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease:a randomised trial. Lancet 2002; 359: 1283-1290.
13 Finkel SI. Effects of rivastigmine on behavioral and psychological symptoms of dementia in Alzheimer’s disease. Clin Ther 2004; 26: 980-990.
14 Finkel SI, Mintzer JE, Dysken M, Krishnan KR, Burt T, McRae T. A randomized, placebo-controlled study of the efficacy and safety of sertraline in the treatment of the behavioral manifestations of Alzheimer’s disease in outpatients treated with donepezil. Int J Geriatr Psychiatry 2004; 19: 9-18.
15 Goddaer J, Abraham IL. Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment. Arch Psychiatr Nurs 1994; 08: 150-158.
16 Hebert R, Dubois MF, Wolfson C, Chambers L, Cohen C. Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of Health and Aging. J Gerontol A Biol Sci Med Sci 2001; 56: M693-M699.
17 Jin H, Meyer JM, Jeste DV. Atypical antipsychotics and glucose dysregulation: a systematic review. Schizophr Res 2004; 71: 195-212.
18 Krieglstein J, Seif EL, Nasr MS, Lippert K. Neurpprotection by memantine as increased by hypothermia and nimodipine. Eur J Pharmacol Sci 1997; 05: 71-77.
19 Lanctot KL, Herrmann N, Mazzotta P. Role of serotonin in the behavioral and psychological symptoms of dementia. J Neuropsychiatry Clin Neurosci 2001; 13: 5-21.
20 Lanctot KL, Herrmann N, Mazzotta P, Khan LR, Ingber N. GABAergic function in Alzheimer’s disease: evidence for dysfunction and potential as a therapeutic target for the treatment of behavioural and psychological symptoms of dementia. Can J Psychiatry 2004; 49: 439-453.
21 Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BM J 2004; 329: 75.
22 Levy ML, Cummings JL, Kahn-Rose R. Neuropsychiatric symptoms and cholinergic therapy for Alzheimer’s disease. Gerontology 1999; 45 Suppl (Suppl. 01) 15-22.
23 Lonergan E, Luxenberg J, Colford J. Haloperidol for agitation in dementia. Cochrane Database Syst Rev 2002; CD002852.
24 Lyketsos CG, DelCampo L, Steinberg M, Miles Q, Steele CD, Munro C, Baker AS, Sheppard JM, Frangakis C, Brandt J, Rabins PV. Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry 2003; 60: 737-746.
25 Nyth AL, Gottfries CG. The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders.A Nordic multicentre study. BrJ Psychiatry 1990; 157: 894-901.
26 Parsons CG, Danysz W, Quack G. Memantine is a clinically well tolerated N-methyl-D-aspartate (NMDA) receptor antagonist–a review of preclinical data. Neuropharmacology 1999; 38: 735-767.
27 Porsteinsson AP, Tariot PN, Erb R, Cox C, Smith E, Jakimovich L, Noviasky J, Kowalski N, Holt CJ, Irvine C. Placebo-controlled study of divalproex sodium for agitation in dementia. Am J Geriatr Psychiatry 2001; 09: 58-66.
28 Reimer MA, Slaughter S, Donaldson C, Currie G, Eliasziw M. Special care facility compared with traditional environments for dementia care:a longitudinal study of quality of life. J Am Geriatr Soc 2004; 52: 1085-1092.
29 Reisberg B, Doody R, Stoffler A, Schmitt F, Ferris S, Mobius HJ. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med 2003; 348: 1333-1341.
30 Remington R. Calming music and hand massage with agitated elderly. Nurs Res 2002; 51: 317-323.
31 Rockwood K, Mintzer J, Truyen L, Wessel T, Wilkinson D. Effects of a flexible galantamine dose in Alzheimer’s disease: a randomised, controlled trial. J Neurol Neurosurg Psychiatry 2001; 71: 589-595.
32 Rovner BW, German PS, Broadhead J, Morriss RK, Brant LJ, Blaustein J, Folstein MF. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr 1990; 02: 13-24.
33 Rovner BW, Kafonek S, Filipp L, Lucas MJ, Folstein MF. Prevalence of mental illness in a community nursing home. Am J Psychiatry 1986; 143: 1446-1449.
34 Rovner BW, Steele CD, Shmuely Y, Folstein MF. A randomized trial of dementia care in nursing homes. J Am Geriatr Soc 1996; 44: 7-13.
35 Ryden MB, Feldt KS. Goal-directed care: caring for aggressive nursing home residents with dementia. J Gerontol Nurs 1992; 18: 35-42.
36 Scarpini E, Scheltens P, Feldman H. Treatment of Alzheimer’s disease: current status and new perspectives. Lancet Neurol 2003; 02: 539-547.
37 Schneider LS, Tariot PN, Dagerman KS, Davis SM, Hsiao JK, Ismail MS, Lebowitz BD, Lyketsos CG, Ryan JM, Stroup TS, Sultzer DL, Weintraub D, Lieberman JA. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med 2006; 355: 1525-1538.
38 Sival RC, Haffmans PM, Jansen PA, Duursma SA, Eikelenboom P. Sodium valproate in the treatment of aggressive behavior in patients with dementia – a randomized placebo controlled clinical trial. Int J Geriatr Psychiatry 2002; 17: 579-585.
39 Tariot PN. Valproate use in neuropsychiatric disorders in the elderly. Psychopharmacol Bull 2003; a37 Suppl (Suppl. 02) 116-128.
40 Tariot PN, Cummings JL, Katz IR, Mintzer J, Perdomo CA, Schwam EM, Whalen E. A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer’s disease in the nursing home setting. J Am Geriatr Soc 2001; 49: 1590-1599.
41 Tariot PN, Erb R, Podgorski CA, Cox C, Patel S, Jakimovich L, Irvine C. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998; 155: 54-61.
42 Tariot PN, Farlow MR, Grossberg GT, Graham SM, McDonald S, Gergel I. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA 2004; 291: 317-324.
43 Tariot PN, Solomon PR, Morris JC, Kershaw P, Lilienfeld S, Ding C. A 5-month, randomized, placebo-controlled trial of galantamine in AD. The Galantamine USA-10 Study Group. Neurology 2000; 54: 2269-2276.
44 van Weert JC, van Dulmen AM, Spreeuwenberg PM, Ribbe MW, Bensing JM. Behavioral and mood effects of snoezelen integrated into 24-hour dementia care. J Am Geriatr Soc 2005; 53: 24-33.
45 Volicer L, Mahoney E, Brown E. Nonpharmacological approaches to the management of the behavioral consequences of advanced dementia. Best Practices for Successful Management: Health Professions Press; 1998: 155-176.
46 Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, Covinsky KE. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA 2002; 287: 2090-2097.