Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India
|
|
- Harriet Skinner
- 5 years ago
- Views:
Transcription
1 Indian J Psychiatry Oct-Dec;; 51(4): doi: / PMCID: PMC Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India 1 Krishna Prasad, Himanshu Gupta, Srikala Bharath, Om Prakash, P. T. Sivakumar, C. Naveen Kumar, Geriatric Clinic and Services, and Mathew Varghese Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore , India 1 Department of Psychiatry, Institute of Human Behaviour & Allied Sciences, Delhi , India Address for correspondence: Dr. Om Prakash, Associate Professor of Psychiatry, Consultant in Adult and Geriatric Psychiatry, Department of Psychiatry, Institute of Human Behaviour & Allied Sciences (IHBAS), Dilshad Garden, Delhi , India. drjhirwalop@yahoo.co.in Copyright Indian Journal of Psychiatry This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Dementia is one of the most disabling disorders afflicting the elderly, with a staggering emotional and economic impact. Antidementia agents have been used for delaying cognitive decline. Antipsychotics are commonly prescribed for behavioral symptoms associated with dementia. Objectives: To explore the use of anti-dementing agents and antipsychotics used in patients with a diagnosis of dementia Materials and Methods: A retrospective chart review method;; geriatric clinic of tertiary care setting. Results: The study sample included 51 consecutive patients with a diagnosis of dementia. The commonest subtype of dementia that was diagnosed was Alzheimer's disease (45%), followed by Frontotemporal dementia (25%).The commonest antidementia drug that was used was donepezil, which alone was prescribed in 27 patients (52%). The commonest antipsychotic used was quetiapine, which was used in 24 patients (47%).
2 Conclusions: The study found donepezil to be the most commonly prescribed antidementia drug and quetiapine to be the most commonly used antipsychotic in a tertiary care geriatric clinic, in a developing country. There is a need to study the costeffectiveness of antidementia and antipsychotic drugs in patients with dementia, in developing countries. Keywords: Antidementia drugs, antipsychotics, dementia, prescription pattern INTRODUCTION Dementia is a silent epidemic afflicting the elderly with a staggering emotional and economic impact, throughout the world, including India. The Delphi consensus study[1] estimated its prevalence to be 1.9% in people above 60 years of age in India and South Asia, with an annual incidence of 4.3/1000. A majority of dementia patients live in third-world countries, representing an underrecognized public health burden. Economic constraints further add to problems in the availability of institutionalized elderly care and a state-sponsored health care system. Evidence-based practice for the management of dementia is also hampered by the lack of clear-cut expert consensus on the efficacy of antidementia drugs.[2] The treatment of dementia varies through the course of the illness, because symptoms evolve over time. Cholinesterase inhibitors that include donepezil, rivastigmine, and galantamine have been recommended for use in mild-tomoderate Alzheimer's dementia. Memantine, a noncompetitive N-methyl d- aspartate (NMDA) antagonist, is the only drug that has been recommended for use in severe dementia, with evidence supporting its use in moderate dementia.[3] Appropriate utilization of antidementia therapy and care management is vitally important for achieving quality of life and care for dementia patients and their caregivers, and for managing the excess costs of Alzheimer's disease.[4] Behavioral and psychological symptoms of dementia (BPSD) are an integral part of the dementia syndrome. Psychosis, agitation, and other behavioral symptoms are reported in patients with dementia causing significant caregiver distress and leading to early institutionalization.[5] The general key elements in the management of BPSD are clarification of target symptoms, ruling out delirium and co-morbid major psychiatric diagnoses, and creatively addressing possible social, environmental, or behavioral remedies. The atypical antipsychotics (Olanzapine, Quetiapine, Risperidone, and Clozapine) have become first-line pharmacological treatments for behavioral symptoms in patients with dementia, because of the perception that they are safer and more effective when compared to the typical antipsychotic medications.[6] However, the increased risk of mortality reported with the use of atypical antipsychotics has resulted in considerable skepticism over their use for behavioral and psychotic symptoms.
3 The prescription pattern of antidementia drugs and antipsychotics in dementia patients has not been studied in developing countries where cost may be the most important factor in determining their choice. We therefore studied retrospectively, patients with cognitive complaints presenting to the tertiary care geriatric clinic of our hospital with an aim to investigate the use of antidementia and antipsychotics drugs prescribed to dementia patients. MATERIALS AND METHODS Study design and sample The study reported in this article was conducted at the Geriatric Clinic Outpatient Department of a tertiary center (NIMHANS, Bangalore, India). This study is a clinical audit based on a retrospective chart review of 51 individuals with an ICD- 10 (International Classification of Diseases and related health problems, tenth revision)[7] diagnosis of dementia and who received outpatient treatment from this center between January and December This was an open, observational study, with an incidental sample (since this was an audit and not a trial). In all patients, the diagnosis was made by a detailed, face-to-face, semi-structured clinical interview by resident doctors in psychiatry utilizing the ICD - 10 criteria. [7] After a detailed workup, the diagnoses were confirmed by independent review and an interview with the patient by one of the four consultant psychiatrists (MV, SB, OP, and PTS), as the standard practice of care in our clinic.[8] The bulk of this study focused on the detailed reading of individual case files of patients. Initially, lists of individuals with ICD-10 diagnosis of dementia were identified from the outpatient services of the geriatric clinic. After identification, these case notes were reviewed, and relevant information was incorporated in the study, mainly focusing on the antidementia and antipsychotic drugs prescribed. The data were suitably coded and extracted on a custom Microsoft excel sheet and analyzed. As this was a chart review of patients already in treatment with voluntary consent, individual informed consent was not obtained. RESULTS Sample characteristics Fifty-one consecutive patients with dementia, who registered at the Geriatric Clinic Outpatient Department of a tertiary center, met the study criteria for the study sample. The mean age of the sample was years. The sample included 23 males (45.1%) and 28 females (54.9%). A majority of the patients belonged to the middle-socioeconomic status (57%). The commonest subtype of dementia that was diagnosed was Alzheimer's disease (45%), followed by fronto-temporal dementia (25%), followed by others,[table 1
4 ]. The HMSE (Hindi Mental State Examination)[9] scores of more than two-thirds of the sample were below 19 and a quarter of the sample had scores below 10 [ Table 2]. Antidementia drugs used The commonest antidementia drug that was used was donepezil, which alone was prescribed in 27 patients (52%). It was prescribed in a dose range of 5 to 10 mg/day. Memantine alone was prescribed in nine patients (18%). A combination of choline-esterase inhibitor and memantine was used in five patients (10%). Galantamine alone was used in three patients only, whereas, Rivastigmine alone was used in a single patient. Six patients (12%) were not prescribed any antidementia drugs. The findings are depicted in Figure 1. Antipsychotics used The commonest antipsychotic used was Quetiapine, which was used in 24 patients (47%). It was used in a dose range of 25 to 300 mg/day. The duration of followup was up to 11 months (range: No follow-up to 11 months;; average six weeks). A similar number of patients did not receive any antipsychotics. A minority of the patients received the other antipsychotics (ie., one patient received Olanzapine, two received Risperidone). The findings are depicted in Figure 2. None of the patients had adverse side effects with all three atypical antipsychotics, although sedation was reported by three patients in the Quetiapine group (12.5%). Four patients were prescribed selective serotonin reuptake inhibitors (SSRIs) and two patients received benzodiazepines. DISCUSSION Dementias are common among elderly patients, but they are poorly recognized and treated in developing countries, including India.[10] To the best of our knowledge, there is no published and accessible research work to date, from India, looking into the prescription pattern in patients with dementia. This study shows that donepezil is the most commonly used antidementia agent, followed by memantine. The single daily dosing, lesser gastrointestinal side-effect profile, and cost of donepezil may have influenced the choice of prescription as compared to other choline-esterase inhibitors and memantine. The clinician's experience with the drug may also have influenced the choice of the antidementia drug. It is important to mention that the cost of antidementia drugs is entirely borne by the patients' family. This could be one of the probable reasons for not starting antidementia drugs for some patients. In terms of comparative effectiveness, there is very little to choose from among the three choline-esterase inhibitors.[11] A systematic review found that the cost savings associated with reducing the mean time spent in full-time care did not offset the cost of treatment with choline-esterase inhibitors sufficiently, to bring
5 the estimated cost-effectiveness to levels generally considered acceptable.[12] The same review remained inconclusive about the cost effectiveness of memantine. From the perspective of a developing country, a Taiwanese costeffectiveness analysis of donepezil found it to be a cost-saving strategy for mildto-moderate AD patients.[13] The study found that quetiapine was the most common antipsychotic used for behavioral and psychotic symptoms. None of the patients were prescribed typical antipsychotics. The lesser propensity of quetiapine to cause extra pyramidal symptoms among the atypical antipsychotics may be the most plausible reason for prescribing it. The sedation that is commonly seen with quetiapine may be the other probable reason for the choice of the drug. The greater metabolic side effect profile of olanzapine and risperidone may also have deterred the use of these drugs in spite of them being cheaper. Antipsychotic drugs should be considered for BPSD only if there is a specific need, or if other treatments have failed;; decision-making should be individualized and documented after a risk-benefit analysis. The results of the phase I outcomes from the Clinical Antipsychotic Trial of Intervention Effectiveness study for Alzheimer's disease (CATIE-AD) suggest that antipsychotics may be more effective for particular symptoms, such as anger, aggression, and paranoid ideas. They do not appear to improve the functioning, care needs, or quality of life.[14] The Food and Drug Administration (FDA), based on a meta-analysis of 17 double-blind randomized placebocontrolled trials among elderly people with dementia, commented that atypical antipsychotics were associated with a significantly ( times) greater mortality risk when compared with placebos. However, there is a paucity of any other evidence-based treatment alternatives to antipsychotics for this population. [5] A watchful waiting strategy, entailing general medical management, nonspecific support, and delayed initiation of antipsychotic pharmacotherapy, has been advocated, in view of it being slightly less expensive and no less effective than immediate treatment with second generation antipsychotic medications.[15] SSRIs were prescribed in a small minority of the patients. The patients who received SSRIs were those with fronto-temporal dementia. Only two patients received benzodiazepines, which were avoided probably due to risks such as falls and amnesia. In summary, the study found donepezil and quetiapine to be the most commonly prescribed antidementia drug and antipsychotic, respectively. There are reasons to exercise caution against our study results as this was a small sample, and has to be taken with all the caveats of a retrospective chart-review design. Notwithstanding the above shortcomings, this investigation has indeed thrown up valuable results that will surely help fine tune the clinical prescription approach to dementia. The audit highlights the need to study the cost-effectiveness of antidementia and antipsychotic drugs for patients with dementia, in developing countries.
6 Footnotes Source of Support: Nil Conflict of Interest: None declared REFERENCES 1. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al. Global prevalence of dementia: A Delphi consensus study. Lancet. 2005;;366: [PMCID: PMC ] [PubMed: ] 2. Shafqat S. Alzheimer disease therapeutics: Perspectives from developing world. J Alzheimers Dis. 2008;;15: [PubMed: ] 3. American Psychiatric Association - Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias. Second Edition Fillit HM, Doody RS, Binaso K, Crooks GM, Ferris SH, Farlow MR, et al. Recommendations for best practices in the treatment of Alzheimer's disease in managed care. Am J Geriatr Pharmacother. 2006;;4:S9 S24. quiz S25-8. [PubMed: ] 5. Jeste DV, Blazer D, Casey D, Meeks T, Salzman C, Schneider L, et al. ACNP White Paper: Update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology. 2008;;33: [PMCID: PMC ] [PubMed: ] 6. Alexopoulos GS, Streim J, Carpenter D, Docherty JP. Expert consensus panel for using antipsychotic drugs in older patients. J Clin Psychiatry. 2004;;65:5 99. [PubMed: ] 7. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. Geneva: WHO;; Prakash O, Naveen Kumar C, Shivakumar PT, Bharath S, Varghese M. Clinical presentation of mania compared with depression: Data from geriatric clinic in India. Int Psychogeriatr. 2009;;21: [PubMed: ] 9. Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry. 2005;;10: Prakash O, Gupta LN, Singh VB, Singhal AK, Verma KK. Profile of psychiatric disorders and life events in medically ill elderly: Experiences from geriatric clinic in Northern India. Int J Geriatr Psychiatry. 2007;;22: [PubMed: ]
7 11. Qaseem A, Snow V, Cross JT, Jr, Forciea MA, Hopkins R, Jr, Shekelle P, et al. Current pharmacologic treatment of dementia: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2008;;148: [PubMed: ] 12. Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, et al. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technol Assess. 2006;;10: Fuh JL, Wang SJ. Cost-effectiveness analysis of donepezil for mild to moderate Alzheimer's disease in Taiwan. Int J Geriatr Psychiatry. 2008;;23:73 8. [PubMed: ] 14. Sultzer DL, Davis SM, Tariot PN, Dagerman KS, Lebowitz BD, Lyketsos CG, et al. Clinical symptom responses to atypical antipsychotic medications in Alzheimer's disease: Phase 1 outcome from the CATIE-AD effectiveness trial. Am J Psychiatry. 2008;;165: [PMCID: PMC ] [PubMed: ] 15. Rosenheck RA, Leslie DL, Sindelar JL, Miller EA, Tariot PN, Dagerman KS, et al. Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease. Arch Gen Psychiatry. 2007;;64: [PubMed: ] Figures and Tables Table 1 Subtypes of diagnosed dementia cases Diagnosis Number of cases (%) Alzheimer's disease 23 (45) Vascular dementia 6 (12) Fronto-temporal dementia 13 (25) Mixed dementia 3 (6) Diffuse lewy body disease 2 (4) Other dementias 4 (8) Table 2 Dementia cases and their HMSE scores HMSE scores Number of cases (%) Less than (25)
8 10 to (39) 19 to 23 3 (6) 24 to 31 6 (12) Not available 9 (18) HMSE = Hindi Mental State Examination)[9] Figure 1 Pie diagram depicting the antidementia drugs used in patients with dementia Figure 2
9 Pie diagram depicting the antipsychotics used in patients with dementia Articles from Indian Journal of Psychiatry are provided here courtesy of Medknow Publications
Behavioural Problems and Patterns of Psychopharmacological Treatment given in Elderly Patients with Dementia
The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 6, Issue 4, DIP: 18.01.090/20180604 DOI: 10.25215/0604.090 http://www.ijip.in October-December, 2018 Research
More informationPsychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias. Aaron H. Kaufman, MD
Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, MD Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, M.D. Health Sciences
More informationMedications for treating people with dementia: summary of evidence on cost-effectiveness
Medications for treating people with dementia: summary of evidence on cost-effectiveness Martin Knapp, A-La Park and Alistair Burns PSSRU, London School of Economics and Political Science v4 23 July 2017
More informationUSING ANTIPSYCHOTICS TO TREAT THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)- WHAT IS THE EVIDENCE?
USING ANTIPSYCHOTICS TO TREAT THE BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD)- WHAT IS THE EVIDENCE? Mugdha Thakur, MD Associate Professor of Psychiatry and Behavioral Sciences Duke University
More informationNeurocognitive Disorders Research to Emerging Therapies
Neurocognitive Disorders Research to Emerging Therapies Edward Huey, MD Assistant Professor of Psychiatry and Neurology The Taub Institute for Research on Alzheimer s Disease and the Aging Brain Columbia
More informationAtypical Antipsychotics and the Risk of Diabetes in an Elderly Population in Long-Term Care: A Retrospective Nursing Home Chart Review Study
Atypical Antipsychotics and the Risk of Diabetes in an Elderly Population in Long-Term Care: A Retrospective Nursing Home Chart Review Study Stewart G. Albert, MD, George T. Grossberg, MD, Papan J. Thaipisuttikul,
More informationPharmacological Treatment of Aggression in the Elderly
Pharmacological Treatment of Aggression in the Elderly Howard Fenn, MD Adjunct Clinical Associate Professor Department of Psychiatry and Behavioral Sciences Stanford University Self-Assessment Question
More informationManagement of the Acutely Agitated Long Term Care Patient
Management of the Acutely Agitated Long Term Care Patient 80 60 Graying of the Population US Population Over Age 65 Millions of Persons 40 20 0 1900 1920 1940 1960 1980 1990 2010 2030 Year Defining Dementia
More informationDRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future
DRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future Daniel S. Sitar Professor Emeritus University of Manitoba Email: Daniel.Sitar@umanitoba.ca March 6, 2018 INTRODUCTION EPIDEMIOLOGY
More informationANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good?
ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good? STEPHANIE M. OZALAS, PHARMD, BCPS, BCGP VA MARYLAND HEALTH CARE SYSTEM BALTIMORE, MD DISCLOSURES Off-label use of medications will be
More information11/11/2016. Disclosures. Natural history of BPSD. Objectives. Assessment of BPSD. Behavioral Management of Persons with Alzheimer s Disease
Disclosures Behavioral Management of Persons with Alzheimer s Disease Wisconsin Association of Medical Directors November 17, 2016 Art Walaszek, M.D. Professor of Psychiatry UW School of Medicine & Public
More informationPsychosis and Agitation in Dementia
Psychosis and Agitation in Dementia Dilip V. Jeste, MD Estelle & Edgar Levi Chair in Aging, Director, Stein Institute for Research on Aging, Distinguished Professor of Psychiatry & Neurosciences, University
More informationTITLE: Memantine in Combination with Cholinesterase Inhibitors for Alzheimer s Disease: Clinical Effectiveness
TITLE: Memantine in Combination with Cholinesterase Inhibitors for Alzheimer s Disease: Clinical Effectiveness DATE: 30 October 2008 RESEARCH QUESTION: What is the evidence for using memantine in combination
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationAntipsychotics for Dementia Under Control or Over-Prescribed?
Antipsychotics for Dementia Under Control or Over-Prescribed? Nathaniel Hedrick, PharmD ProCare HospiceCare, Manager of Clinical Services Learning Objectives Summarize the disease progression and most
More informationBehavioral and Psychological Symptoms of dementia (BPSD)
Behavioral and Psychological Symptoms of dementia (BPSD) Chris Collins - Old Age Psychiatrist, Christchurch chris.collins@cdhb.health.nz Approaching BPSD: the right mindset Assessment Non-drug management
More informationDEMENTIA AND MEDICATION
DEMENTIA AND MEDICATION Dr. Siobhan Ni Bhriain, MRCP, MRCPsych. Clinical Director, Tallaght and SJH MHS, Consultant Old Age Psychiatrist, Chair, DSIDC Steering Committee. SUMMARY OF TODAY S TALK Dementia-definition,
More informationPlease Join Us. International Psychogeriatric Association. Dependency Ratio. Geriatric Psychiatry in the 21st Century: A Global Perspective
International Psychogeriatric Association Please Join Us Geriatric Psychiatry in the 21st Century: A Global Perspective Jacobo Mintzer M.D. Executive Director Roper Saint Frances Clinical and Biotechnology
More informationDisclosure. Speaker Bureaus. Grant Support. Pfizer Forest Norvartis. Pan American Health Organization/WHO NIA HRSA
Disclosure Speaker Bureaus Pfizer Forest Norvartis Grant Support Pan American Health Organization/WHO NIA HRSA How Common is Psychosis in Alzheimer s Disease? Review of 55 studies 41% of those with Alzheimer
More informationResearch Article Drug Utilization Pattern in Patients with Different Types of Dementia in Western India
International Journal of Alzheimer s Disease, Article ID 43522, 9 pages http://dx.doi.org/1.1155/214/43522 Research Article Drug Utilization Pattern in Patients with Different Types of Dementia in Western
More informationMulti-morbidity in Dementia: A 21st Century Challenge. Sube Banerjee. Professor of Dementia Brighton and Sussex Medical School
Multi-morbidity in Dementia: A 21st Century Challenge Sube Banerjee Professor of Dementia Brighton and Sussex Medical School Most people of any age with any long term condition have multiple conditions
More informationPDFlib PLOP: PDF Linearization, Optimization, Protection. Page inserted by evaluation version
PDFlib PLOP: PDF Linearization, Optimization, Protection Page inserted by evaluation version www.pdflib.com sales@pdflib.com doi:10.1111/j.1479-8301.2007.00215.x PSYCHOGERIATRICS 2008; 8: 32 37 REVIEW
More informationPharmacological Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) Gurdeep K Major St. Charles Hospital
Pharmacological Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) Gurdeep K Major St. Charles Hospital with thanks to Jonathan Cavan for his input Aims Define BPSD and common symptoms
More informationRational Medication Use in Dementia
Rational Medication Use in Dementia Stephen Thielke sthielke@u.washington.edu (206) 764 2815 I have no conflicts of interest to report. I am an employee of the federal government. The opinions in this
More informationDiagnosis and Treatment of Alzhiemer s Disease
Diagnosis and Treatment of Alzhiemer s Disease Roy Yaari, MD, MAS Director, Memory Disorders Clinic, Banner Alzheimer s Institute 602-839-6900 Outline Introduction Alzheimer s disease (AD)Guidelines -revised
More informationAppendix K: Evidence review flow charts
K.1 Dementia diagnosis K.1.1 Dementia diagnosis What are the most effective methods of primary assessment to decide whether a person with suspected dementia should be referred to a dementia service? What
More informationDEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.
DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that
More informationPsychotropic Strategies Handout Package
Psychotropic Strategies Handout Package Psychotropic Strategies Learning Objectives Utilize all clinical information available Assess the patient s overall condition this is essential Basic Principles
More informationResearch Journal of Pharmaceutical, Biological and Chemical Sciences
Research Journal of Pharmaceutical, Biological and Chemical Sciences Prescribing Pattern of Antipsychotics In A Tertiary Care Hospital, Salem: A Retrospective Study. B Arul 1 *, E Manivannan 2, R Kothai
More informationNeuroPharmac Journal ISSN: Alzheimer s Disease: Pharmacotherapy of noncognitive symptoms Aslam Pathan; Abdulrahman M.
ISSNISSN ISSN: 2456-3927 NeuroPharmac Journal Alzheimer s Disease: Pharmacotherapy of noncognitive symptoms Aslam Pathan; Abdulrahman M. Alshahrani www. neuropharmac.com Jan-April 2018, Volume 3, Issue
More informationCambridge University Press Effective Treatments in Psychiatry Peter Tyrer and Kenneth R. Silk Excerpt More information
Organic disorders 1 Delirium Based on Delirium by Laura Gage and David K. Conn in Effective Treatments in Psychiatry, Cambridge University Press, 2008 Introduction Delirium needs treatment for both its
More informationMORTALITY ASSOCIATED WITH USE OF ANTIPSYCHOTICS IN DEMENTIA: REVIEWING THE EVIDENCE
MORTALITY ASSOCIATED WITH USE OF ANTIPSYCHOTICS IN DEMENTIA: REVIEWING THE EVIDENCE KRISTA L. LANCTÔT, PHD PROFESSOR OF PSYCHIATRY AND PHARMACOLOGY, UNIVERSITY OF TORONTO; SENIOR SCIENTIST, HURVITZ BRAIN
More informationAn Evaluation of a Training Program in Restraint-Free Care for Individuals with Dementia Christina Garrison-Diehn, Clair Rummel, & Jane E.
An Evaluation of a Training Program in Restraint-Free Care for Individuals with Dementia Christina Garrison-Diehn, Clair Rummel, & Jane E. Fisher Background Disease. (Xu, Kochanek & Tejada-Vera, 2009)
More informationTreatment of behavioral and psychological symptoms of dementia: a systematic review
Psychiatr. Pol. 2016; 50(4): 679 715 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: http://dx.doi.org/10.12740/pp/64477 Treatment of behavioral and psychological symptoms
More informationThe place for treatments of associated neuropsychiatric and other symptoms
The place for treatments of associated neuropsychiatric and other symptoms Luca Pani dg@aifa.gov.it London, 25 th November 2014 Workshop on Alzheimer s Disease European Medicines Agency London, UK Public
More informationUp to 90% of people with dementia experience
Focus on CME at the University of Calgary Getting Aggressive with Dementia Adrienne Cohen, MD, BSc, FRCPC Presented at Behaviour Problems in the Elderly, video-audio conference, 2003 Up to 90% of people
More informationCognitive enhancers PINCH ME. Anticholinergic burden BPSD. Agitation, Aggression and antipsychotics
Cognitive enhancers PINCH ME Anticholinergic burden BPSD Agitation, Aggression and antipsychotics 2 types Cholinesterase inhibitors licensed for mild to moderate AD Donepezil Galantamine Rivastigmine also
More informationManagement of Agitation in Dementia. Kimberly Triplett Ferguson, MS4
Management of Agitation in Dementia Kimberly Triplett Ferguson, MS4 Objectives 1. Review recommended evaluation of agitated patients with dementia. 2. Discuss evidence concerning nonpharmacologic management.
More informationI received help from Bosch Health Care
John Kasckow, MD, PhD VA Pittsburgh Health Care System Western Psychiatric Institute and Clinic, UPMC VA Pittsburgh Health Care System I received help from Bosch Health Care 1 Diagnoses of Interest Early
More informationPrescribing for people with dementia. Carol Paton Chief Pharmacist April 2009
Prescribing for people with dementia Carol Paton Chief Pharmacist April 2009 What are the issues? 1. Minimising cognitive side effects from prescribed medicines 2. Prescribing memory enhancing drugs 3.
More informationNovember 16-18, 2017 Hotel Monteleone New Orleans, LA. Provided by
November 16-18, 2017 Hotel Monteleone New Orleans, LA Provided by Major Neurocognitive Disorder: The Beginning and the End. Making the Diagnosis and Addressing Distressing Behavior W. Vaughn McCall, MD,
More informationUse of Anti-Psychotic Agents in Irish Long Term Care Residents with Dementia
Use of Anti-Psychotic Agents in Irish Long Term Care Residents with Dementia Aine Leen, Kieran Walsh, David O Sullivan, Denis O Mahony, Stephen Byrne, Margaret Bermingham Pharmaceutical Care Research Group,
More informationDementia Care Pathway
Document level: West Locality Code: CC41 Issue number: 1 Dementia Care Pathway Lead executive Authors details Type of document Target audience Document purpose Medical Director Dr Anushta Sivananthan Dr
More informationBEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS IN DEMENTIA
BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS IN DEMENTIA Unmet needs What might be your behavioural response to this experience? Content Definition What are BPSD? Prevalence How common are they? Aetiological
More informationKnown as both a thief and murderer,
&A Dementia Drugs: When Should They Be Stopped? Ron Keren, MD, FRCPC As presented at the University of Toronto s Primary Care Conference, Toronto, Ontario (May 25) Known as both a thief and murderer, Alzheimer
More informationBEHAVIORAL PROBLEMS IN DEMENTIA
BEHAVIORAL PROBLEMS IN DEMENTIA CLINICAL FEATURES Particularly as dementia progresses, psychiatric symptoms may develop that resemble discrete mental disorders such as depression or mania The course and
More informationSocial Support and Mental Health of the Elderly in South India
Social Support and Mental Health of the Elderly in South India Teddy Andrews J Senior Grade Lecturer Social Work Department of Public Health Manipal University Manipal. India Overview Introduction Objectives
More informationAssessment and management of behavioral and psychological symptoms of dementia
Assessment and management of behavioral and psychological symptoms of dementia Helen C Kales, 1 2 3 Laura N Gitlin, 4 5 6 Constantine G Lyketsos 7 1 Section of Geriatric Psychiatry, Department of Psychiatry,
More information2006, Editrice Kurtis
Aging Clinical and Experimental Research Pharmacological treatment of Alzheimer s Disease* Angelo Bianchetti 1, Piera Ranieri 1, Alessandro Margiotta 1, and Marco Trabucchi 2 1 Department of Medicine,
More informationCHCS. Multimorbidity Pattern Analyses and Clinical Opportunities: Dementia. Center for Health Care Strategies, Inc. FACES OF MEDICAID DATA SERIES
CHCS Center for Health Care Strategies, Inc. FACES OF MEDICAID DATA SERIES Multimorbidity Pattern Analyses and Clinical Opportunities: Dementia December 2010 Cynthia Boyd, MD, MPH* Bruce Leff, MD* Carlos
More informationThe efficacy of Rivastigmine in the management of the behavioral and psychological symptoms of lewy body dementia- a review of literature
Review article: The efficacy of Rivastigmine in the management of the behavioral and psychological symptoms of lewy body dementia- a review of literature Dr. Ivan Netto 1, Aditya Iyer 2, Dr. Prathamesh
More informationLiterature Scan: Alzheimer s Drugs
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationDebra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist. HMS Training Webinar January 27, 2017
Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist HMS Training Webinar January 27, 2017 1 Describe nationwide prevalence and types of elderly dementia + define BPSD Define psychotropic
More informationMEDICATIONS IN MANAGING DIFFICULT BEHAVIORS
MEDICATIONS IN MANAGING DIFFICULT BEHAVIORS A REALITY CHECK reality check Noun informal an occasion on which one is reminded of the state of things in the real world. ROBERT LACOSTE, MD MEDICAL DIRECTOR,
More informationPRESCRIBING FOR PEOPLE WITH DEMENTIA; SELECTED FINDINGS FROM POMH-UK QUALITY IMPROVEMENT PROGRAMMES (QIPS)
PRESCRIBING FOR PEOPLE WITH DEMENTIA; SELECTED FINDINGS FROM POMH-UK QUALITY IMPROVEMENT PROGRAMMES (QIPS) The Prescribing Observatory for Mental Health (POMH-UK) is a national initiative to improve the
More informationAlzheimer dementia: Starting, stopping drug therapy
REVIEW LUKE D. KIM, MD, FACP, CMD Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Center for Geriatric Medicine, Medicine
More informationPsychotropic Medication Use in Canadian Long-Term Care Patients Referred for Psychogeriatric Consultation
Original Research Psychotropic Medication Use in Canadian Long-Term Care Patients Referred for Psychogeriatric Consultation Corinne E. Fischer, MD 1,2,3, Carole Cohen, MD 3,4, Lauren Forrest, BSc 3, Tom
More informationThe Agitated. Older Patient: old. What To Do? Michelle Gibson, MD, CCFP Presented at Brockville General Hospital Rounds, May 2003
Focus on CME at Queen s University Focus on CME at Queen s University The Agitated The Older Patient: What To Do? Michelle Gibson, MD, CCFP Presented at Brockville General Hospital Rounds, May 2003 Both
More informationDementia is a common neuropsychiatric disorder characterized by progressive impairment of
Focused Issue of This Month Diagnosis and Treatment for Behavioral and Psychological Symptoms of Dementia Byoung Hoon Oh, MD Department of Psychiatry, Yonsei University College of Medicine E - mail : drobh@yuhs.ac
More informationDouglas Leslie, Ph.D.
Douglas Leslie, Ph.D. All Publications 1. Beam-Goulet J, Rosenheck RA and Leslie DL. Effectiveness of a Targeted Mailing Outreach Program on Supplemental Security Income Applications and Awards. Social
More informationPsychotropic Medication. Including Role of Gradual Dose Reductions
Psychotropic Medication Including Role of Gradual Dose Reductions What are they? The phrase psychotropic drugs is a technical term for psychiatric medicines that alter chemical levels in the brain which
More informationOrganization: Sheppard Pratt Health System Solution Title: Lean Methodology: Appropriate Antipsychotic Use on an Inpatient Dementia Unit
Organization: Sheppard Pratt Health System Solution Title: Lean Methodology: Appropriate Antipsychotic Use on an Inpatient Dementia Unit Problem: For dementia patients, antipsychotic medications are prescribed
More informationSilvia Duong, 1,2 Kam-Tong Yeung, 1 and Feng Chang 1,3. 1. Introduction
Aging Research Volume 2015, Article ID 570410, 6 pages http://dx.doi.org/10.1155/2015/570410 Research Article Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized
More informationClinical Trial Designs for RCTs focussing on the Treatment of Agitation in people with Alzheimer s disease
Clinical Trial Designs for RCTs focussing on the Treatment of Agitation in people with Alzheimer s disease Professor Clive Ballard Dr Byron Creese University of Exeter, UK Guardian guide for 2018: Top
More informationCurrent Treatments for Dementia and Future Prospects. James Warner St Charles Hospital, London
Current Treatments for Dementia and Future Prospects James Warner St Charles Hospital, London Dementia Cognitive Non-cognitive (BPSD) Memory orientation language other cognitive abilities praxis planning
More informationEvidence-Based Interventions to Improve Caregiver and Patient Outcomes in Dementia
Evidence-Based Interventions to Improve Caregiver and Patient Outcomes in Dementia Alan B. Stevens, PhD Professor, Department of Medicine Vernon D. Holleman-Lewis M. Rampy Centennial Chair in Gerontology
More informationDementia NICE Guidelines Update. Key points for primary care - NICE guideline (June 2018 update ) 26 September 2018
Dementia NICE Guidelines Update Key points for primary care - NICE guideline (June 2018 update ) 26 September 2018 How NICE guidelines are reviewed Multidisciplinary guideline committee established Review
More informationBurden of behavioral and psychiatric symptoms in people screened positive for dementia in primary care results of the DelpHi-study René Thyrian
Burden of behavioral and psychiatric symptoms in people screened positive for dementia in primary care results of the DelpHi-study René Thyrian German Center for Neurodegenerative Diseases (DZNE), site
More informationAny interventions, where RCTs in PD are not available, are not included in the tables.
Tables Interventions where new studies have been published are indicated in bold italics. Changes in conclusions are indicated in italics and are highlighted in yellow. Any interventions, where RCTs in
More informationDementia of the Alzheimer Type: the Drug Treatment Debate
Dementia of the Alzheimer Type: the Drug Treatment Debate I have no financial conflict of interest. Many years ago I was given a trip to San Fran and taught to use a slide set from the drug company. I
More informationMedication alternatives for behavioural disturbance
Neurology 13 Medication alternatives for behavioural disturbance Many patients with dementia will in the later stages develop distressing behavioural symptoms. Antipsychotics are commonly used to treat
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (Review of TA 111) Appraisal
More informationA review approach of Alzheimer Disease and Pharmacological Management
53 A review approach of Alzheimer Disease and Pharmacological Management Senthamil Selvan T Pharmaceutical Technical service department, Mylan Laboratories Limited, Tamilnadu, India pharmtamil@gmail.com
More informationDelirium Monograph - Update, Spring 2014
Delirium Monograph - Update, Spring 2014 Since publication of the APM monograph on Delirium in January 2012, three structured reviews have been published adding data relevant to the practice of identification,
More informationKONO METHOD FOR DEMENTIA" - FROM THE VIEW POINT OF CLINICAL PHARMACOLOGY-
32th JSCPT/Hamamatsu, JPN/2011/12/03 3-O-03 A CONSIDERATION ON THE COMBINATION DRUG THERAPY KONO METHOD FOR DEMENTIA" - FROM THE VIEW POINT OF CLINICAL PHARMACOLOGY- TAKEO SAIO (FUJI TORANOMON HEALTH PROMOTION
More informationBehavioral and Psychological Symptoms of Dementia
Behavioral and Psychological Symptoms of Dementia Akarachaid Pinidbunjerdkool MD*, Sansanee Saengwanitch MD*, Pasiri Sithinamsuwan MD* * Division of Neurology, Department of Medicine, Phramongkutklao Hospital
More informationClinical Policy: Rivastigmine (Exelon) Reference Number: CP.PMN.101 Effective Date: Last Review Date: 02.18
Clinical Policy: (Exelon) Reference Number: CP.PMN.101 Effective Date: 03.01.17 Last Review Date: 02.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationPsychiatric and behavioral symptoms are common in
Article Clinical Symptom Responses to Atypical Antipsychotic Medications in Alzheimer s Disease: Phase 1 Outcomes From the CATIE-AD Effectiveness Trial David L. Sultzer, M.D. Sonia M. Davis, Dr.P.H. Pierre
More informationMedications and Non-Pharma Approaches to Treatment. David J. Irwin, MD Penn Frontotemporal Degeneration Center
Medications and Non-Pharma Approaches to Treatment David J. Irwin, MD Penn Frontotemporal Degeneration Center Outline Non-Pharmacological Treatment Strategies Behavior Language Motor Supportive Care Check-points
More informationPRESCRIPTION PATTERNS OF PSYCHOTROPIC DRUGS
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Anantha et al. SJIF Impact Factor 2.786 Volume 4, Issue 03, 725-730. Research Article ISSN 2278 4357 PRESCRIPTION PATTERNS OF PSYCHOTROPIC DRUGS Swapna
More informationThe world is graying: Dementia is an alarming issue
Guest Editorial Paper Sapkota et.al. N Sapkota, Fellowship (Geriatric Psychiatry) Associate Professor and Head, Department of Psychiatry B.P. Koirala Institute of Health Sciences, Dharan, Nepal The world's
More informationUDS Progress Report. -Standardization and Training Meeting 11/18/05, Chicago. -Data Managers Meeting 1/20/06, Chicago
UDS Progress Report -Standardization and Training Meeting 11/18/05, Chicago -Data Managers Meeting 1/20/06, Chicago -Training material available: Gold standard UDS informant and participant interviews
More informationPsychiatric Morbidity in Dementia Patients in a Neurology-Based Memory Clinic
Original Articles 179 Psychiatric Morbidity in Dementia Patients in a Neurology-Based Memory Clinic Ching-Sen Shih 1, Sui-Hing Yan 2, Ying-Hoo Ho 1, Yuh-Te Lin 1, Jie-Yuan Li 1, and Yuk-Keung Lo 1 Abstract-
More informationThe prevalence of dementia increases from. Pharmacological management of behavioural disturbance in patients with dementia. Dementia.
Dementia Pharmacological management of behavioural disturbance in patients with dementia Management of behavioural disturbance in the setting of dementia can be challenging. There are many potential causes
More information9/11/2012. Clare I. Hays, MD, CMD
Clare I. Hays, MD, CMD Review regulatory background for current CMS emphasis on antipsychotics Understand the risks and (limited) benefits of antipsychotic medications Review non-pharmacologic management
More informationGuidelines for the Management of Behavioural and Psychological Symptoms of Dementia (BPSD) Summary document for Primary Care
Guidelines for the Management of Behavioural and Psychological Symptoms of Dementia (BPSD) Summary document for Primary Care Guidelines for the Management of Behavioural and Psychological Symptoms of Dementia
More informationMental Health Subcommittee of PTAC meeting held 21 June (minutes for web publishing)
Mental Health Subcommittee of PTAC meeting held 21 June 2010 (minutes for web publishing) Mental Health Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology
More informationPresented by Rengena Chan-Ting, DO, CMD, FACOI Jenna D. Toniatti, PharmD
Presented by Rengena Chan-Ting, DO, CMD, FACOI Jenna D. Toniatti, PharmD Define BPSD and review the spectrum of associated symptoms Review pharmacologic and non-pharmacologic treatments for BPSD Evaluate
More informationDonepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of TA 111)
National Institute for Health and Clinical Excellence Health Technology Appraisal Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of TA 111) Response
More informationAppendix D: Included Studies adverse effects review
DELIRIUM APPENDICES (Draft for Consultation) Appendix D: Included Studies adverse effects review Table D1: Studies directly comparing two antipsychotic agents in delirium Author Study design Setting Age
More information-Guidelines for the discontinuation of oral antipsychotics in patients with BPSD within the primary care setting Summary- Quetiapine
-Guidelines for the discontinuation of oral antipsychotics in patients with BPSD within the primary care setting Summary- Quetiapine An independent report Time for action 1 by Professor Sube Banerjee looked
More informationNationwide study of antipsychotic use among community-dwelling persons with Alzheimer s disease in Finland
International Psychogeriatrics (2011), 23:10, 1623 1631 C International Psychogeriatric Association 2011 doi:10.1017/s1041610211001621 Nationwide study of antipsychotic use among community-dwelling persons
More informationPharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018
Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018 Mary Ellen Quiceno, MD, FAAN Associate Professor of Neurology UNTHSC Center for Geriatrics 855 Montgomery Street, PCC 4, Ft.
More informationAssessing and Treating Agitation Associated with Alzheimer s Disease
AXS-05 R&D Day April 24, 2018 Assessing and Treating Agitation Associated with Alzheimer s Disease Marc E. Agronin, MD VP, Behavioral Health and Clinical Research, Miami Jewish Health Affiliate Associate
More informationDiscontinuing Dementia Medications Case April Patient Case
Discontinuing Dementia Medications Case April 2017 Patient Case MJ is an 86 year-old female with a primary diagnosis of Alzheimer s disease and history of anemia, cystitis, depression, Type II DM, HTN,
More informationBackground. Population/Intervention(s)/Comparison/Outcome(s) (PICO) Role of antidepressants in people with dementia and associated depression
updated 2012 Role of antidepressants in people with dementia and associated depression Q4: For people with dementia with associated depression, do antidepressants when compared to placebo/comparator produce
More informationBPSD%What&to&do?&& Geriatric&Refresher&Day&& 11:30#12:30,&Wed&March&4 th,&2015& St&Elias&Centre,&OCawa&Ontario& &
RGPEO% Regional&Geriatric&Program&of&Eastern&Ontario& BPSD%What&to&do?&& Geriatric&Refresher&Day&& 11:30#12:30,&Wed&March&4 th,&2015& St&Elias&Centre,&OCawa&Ontario& & Behavioural&and& Psychological& Symptoms&&
More informationEPIDEMIOLOGICAL CHARACTERISTICS OF DEMENTIA TREATMENT IN CROATIA
Psychiatria Danubina, 2016; Vol. 28, No. 2, pp 170-175 Medicinska naklada - Zagreb, Croatia Original paper EPIDEMIOLOGICAL CHARACTERISTICS OF DEMENTIA TREATMENT IN CROATIA Sanja Tomasović 1,2, Josip Sremec
More informationPharmacotherapeutic aspects of dementia care in Malta
Review Article Pharmacotherapeutic aspects of dementia care in Malta Charles Scerri, Stephen Abela, Anthea Innes Abstract Dementia is the most common neurodegenerative disorder of old age affecting one
More informationDementia Pharmacotherapy
Dementia Pharmacotherapy 1 early therapeutic interventions can maximize pharmacologic efficacy with these agents 2 Selecting a Medication Not enough evidence to recommend one agent over another based on
More information