ABSTRACT
Alzheimer's disease is becoming a social, political, and economic issue as a result of both the growing number of people affected and the enormous economic, social, and emotional costs involved in caring for Alzheimer's patients. The aim of this study is to evaluate the effects of a multimodal intervention program for patients with Alzheimer's disease and their caregivers. The study was conducted on a sample of 32 subjects: 16 Alzheimer's patients and their caregivers. The results obtained after the multimodal rehabilitation program showed that the Alzheimer's patients had a more stable cognitive status and improved mood. Regarding the psychoeducational program, the results demonstrate the efficacy of such interventions in terms of increasing and preserving the caregivers' coping skills and enhancing their perception of the value of support groups.
Subject(s)
Alzheimer Disease/rehabilitation , Caregivers/education , Cognition Disorders/rehabilitation , Cognitive Behavioral Therapy/methods , Health Education , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Cognition Disorders/diagnosis , Cognition Disorders/epidemiology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Female , Humans , Male , Neuropsychological Tests , Personal Autonomy , Program Development , Surveys and QuestionnairesABSTRACT
Dementia is a neuropsychiatric disorder characterized by cognitive impairment and behavioral and psychological symptoms. The efficacy and tolerability of risperidone for treating dementia-associated psychological and behavioral disturbances were evaluated in a study of 135 patients aged 60-85 years with DSM-IV diagnoses of Alzheimer's disease. All were treated with risperidone at a starting dose of 0.5 mg once daily at bedtime. After the first 3 days of therapy the dosage was increased to 1 mg in 2 doses (morning and evening), then a further 0.5 mg was added (alternatively in the morning and in the evening) every three days until attenuation of the psychiatric symptoms. The response to treatment was evaluated for a period of 12 weeks by the Neuropsychiatric Inventory (NPI) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Both NPI and BEHAVE-AD were administered at the baseline visit, and after 4 and 12 weeks of therapy. Tolerability was assessed by the incidence of clinically evident side effects. The mean dose at endpoint was 1 mg/day of risperidone. The mean NPI score was 28.80+/-13.92 at start, 15.55+/-11.25 after 4 weeks and 8.30+/-7.00 at endpoint. The reduction in mean scores at 4 and 12 weeks was statistically significant in most of the Neuropsychiatric Inventory items, except for appetite disorders (p<0.0001). The mean BEHAVE-AD score was 20.44+/-3.92 at start, 13.50+/-11.39 after 4 weeks and 8.03+/-7.80 at endpoint. All the items showed a statistically significant improvement after 4 and 12 weeks (p<0.0001). The results were better at 12 than at 4 weeks. In our elderly patients with dementia low-dose risperidone was well tolerated and associated with reductions in BPSD, in particular agitation, aggression, irritability, delusions, sleep disorders, anxiety and phobias.
Subject(s)
Alzheimer Disease/drug therapy , Alzheimer Disease/psychology , Antipsychotic Agents/therapeutic use , Behavior/drug effects , Risperidone/therapeutic use , Aged , Aged, 80 and over , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Risperidone/administration & dosage , Risperidone/adverse effectsABSTRACT
Behavioral symptoms start to appear in mild and moderate dementia and become increasingly severe with the progression of the disease. Agitation, aggressiveness, and psychosis can be seen in Alzheimer's disease, and in particular are common manifestations in Lewy body dementia. It is the behavioral disturbances rather than the cognitive disorders that are more often the cause of the institutionalization of these patients because of the heavy assistance and emotional burden they represent for caregivers. Traditionally, these kinds of symptoms were controlled by classical antipsychotic agents, which after long-term use cause severe extrapyramidal effects, late dyskinesia, sedation, orthostatic hypotension, and cognitive function impairment. More recently, atypical antipsychotic agents have shown a better tolerability profile, with a reduced incidence of extrapyramidal effects, orthostatic hypotension, sedation, and a reduced impact on cognitive function. The aim of this study is to evaluate the efficacy and tolerability of quetiapine in a group of patients with a diagnosis of dementia and concomitant psychotic disorders. The response to treatment was evaluated by the Neuropsychiatric Inventory (NPI) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). The NPI and BEHAVE-AD were administered at baseline and after 4 weeks and 12 weeks of therapy. Tolerability was assessed by the incidence of clinically evident side effects. The results show that quetiapine is effective in reducing behavioral symptoms, deliria and hallucinations, aggressiveness, and sleep disturbances. Quetiapine tolerability proved to be satisfactory. The only side effect of clinical significance was orthostatic hypotension, which was, however, partially preventable by a slower drug titration.
