Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. OBJECTIVES: The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. METHODS: A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. RESULTS: A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. CONCLUSIONS: The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver's quality of life.

Patología asociada al deterioro cognitivo leve. Factores de riesgo y predictivos / Disorders associated with mild cognitive impairment. Risk factors and predictors

Clásicamente se han involucrado en el deterioro cognitivo, además del propio envejecimiento, una serie de factores de comorbilidad que intervienen de forma concomitante y retroalimentándose en el continuum de la enfermedad desde las fases prodrómicas. Entre ellos cabe destacar el delirium, las alteraciones nutricionales, del equilibrio y la marcha, infecciones e incluso la progresiva incidencia de neoplasias, pero quizás sea la iatrogenia medicamentosa, y no solo de psicofármacos, la que debe de estar siempre presente en nuestro afinamiento diagnóstico y de estadificación. Entre los factores de riesgo y factores predictivos de evolución a demencia destacamos no solo los tradicionales como hipertensión arterial, hiperglucemia, hiperlipemia, tabaco, alcohol o síndrome metabólico, sino los más emergentes como fibrilación auricular, inflamación, hiperhomocisteinemia o insuficiencia cardíaca. Por último, es destacable que en edades más longevas cobra más importancia, paradójicamente, la prevención de hipotensión, hipoglucemia, bradicardia, bajo gasto e incluso la malnutrición como factores de riesgo. Finalmente, algunas variables cognitivas como memoria, habilidad lingüística, capacidad lectora y algunas alteraciones en la esfera afectiva deben también valorarse como factores predictivos del deterioro cognitivo leve (AU)

Traditionally, cognitive impairment has been associated not only with ageing itself but also with concomitant comorbidities that interact in the disease continuum from the prodromic phases. Notable among these are delirium, nutritional alterations, balance and gait, infections and even a progressive incidence of neoplasms. However, with regard to diagnosis and staging, clinicians should perhaps remain especially alert to the possibility of pharmacological iatrogeny, which is not limited to psychopharmacological treatment. Traditional risk factors for cognitive impairment and factors predictive of progression to dementia include hypertension, hyperglycaemia, hyperlipidaemia, smoking, alcohol, and metabolic syndrome. Emerging factors include atrial fibrillation, inflammation, hyperhomocysteinaemia, and heart failure. Paradoxically, prevention of risk factors such as hypotension, hypoglycaemia, bradycardia, low cardiac output and even malnutrition become more important at more advanced ages. Lastly, some cognitive variables such as memory, language and reading abilities, and some alterations in the affective sphere should also be assessed as predictive factors for mild cognitive impairment (AU)

[Disorders associated with mild cognitive impairment. Risk factors and predictors]. / Patología asociada al deterioro cognitivo leve. Factores de riesgo y predictivos.

Traditionally, cognitive impairment has been associated not only with ageing itself but also with concomitant comorbidities that interact in the disease continuum from the prodromic phases. Notable among these are delirium, nutritional alterations, balance and gait, infections and even a progressive incidence of neoplasms. However, with regard to diagnosis and staging, clinicians should perhaps remain especially alert to the possibility of pharmacological iatrogeny, which is not limited to psychopharmacological treatment. Traditional risk factors for cognitive impairment and factors predictive of progression to dementia include hypertension, hyperglycaemia, hyperlipidaemia, smoking, alcohol, and metabolic syndrome. Emerging factors include atrial fibrillation, inflammation, hyperhomocysteinaemia, and heart failure. Paradoxically, prevention of risk factors such as hypotension, hypoglycaemia, bradycardia, low cardiac output and even malnutrition become more important at more advanced ages. Lastly, some cognitive variables such as memory, language and reading abilities, and some alterations in the affective sphere should also be assessed as predictive factors for mild cognitive impairment.