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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(12): 1152-1162
DOI: 10.1055/s-0043-1777774
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Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management

Sintomas comportamentais ou neuropsiquiátricos da doença de Alzheimer: psicopatologia e abordagem terapêutica
Antonio Lucio Teixeira 
1   University of Texas University of Texas Health Science Center, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, Neuropsychiatry Program, Houston, Texas, United States.
2   Faculdade Santa Casa Belo Horizonte, Belo Horizonte MG, Brazil.
,
Natalia Pessoa Rocha 
3   University of Texas Health Science Center, McGovern Medical School, Department of Neurology, Houston, Texas, United States.
,
Jennifer Gatchel 
4   Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts, United States.
5   Baylor College of Medicine, Department of Psychiatry, Houston, Texas, United States.
6   Michael E. Debakey VA Medical Center, Houston, Texas, United States.
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Abstract

Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of “mild behavioral impairment”, the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.

Resumo

Sintomas neuropsiquiátricos ou comportamentais de demência envolvem uma série de condições, como ansiedade, depressão, apatia, psicose e agitação, frequentemente observadas em indivíduos com demência. Embora esses sintomas não sejam necessários para o diagnóstico da doença de Alzheimer, estão presentes em todas as fases ou estágios da doença, contribuindo negativamente para o declínio cognitivo, comprometimento funcional e sobrecarga do cuidador. Os sintomas neuropsiquiátricos têm sido conceituados não apenas como fatores de risco, mas também como marcadores clínicos de progressão da doença de Alzheimer. O construto “comprometimento comportamental leve”, correlato comportamental do comprometimento cognitive leve, tem sido proposto nesse contexto. Os primeiros passos na abordagem dos sintomas comportamentais da doença de Alzheimer envolvem definir os alvos-terapêuticos e investigar potenciais causas ou fatores agravantes. Após intervir nesses fatores, abordagens não farmacológicas constituem a primeira linha de intervenção. Depois da otimização do tratamento anticolinesterásico, terapias farmacológicas específicas (por exemplo, antidepressivos, antipsicóticos) podem ser consideradas, levando-se em conta potencias efeitos colaterais.

Keywords

Alzheimer Disease - Neuropsychiatry - Apathy - Depression - Anxiety - Psychomotor Agitation - Psychotic Disorders - Sleep

Palavras-chave

Doença de Alzheimer - Neuropsiquiatria - Apatia - Depressão - Ansiedade - Agitação Psicomotora - Transtornos Psicóticos - Sono

Authors' Contributions

ALT conceptualized the manuscript; ALT and NPR drafted the first version; JG reviewed it critically and contributed to the final version. All authors have read and approved the final version of the manuscript.




Publikationsverlauf

Eingereicht: 15. September 2023

Angenommen: 08. November 2023

Artikel online veröffentlicht:
29. Dezember 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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