Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018

Size: px
Start display at page:

Download "Pharmacological Treatments for Neuropsychiatric Symptoms in Dementia 3/22/2018"

Transcription

1 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. Worth, TX (817) Associate Professor of Medical Education TCU & UNTHSC School of Medicine Texas Council on Alzheimer s Disease and Related Dementias

2 Disclosures Eli Lilly: Speaker s Bureau Adamas: Consultant NIH, Eli Lilly: Research Support Since there are no FDA approved medications for most neuropsychiatric symptoms in dementia, I will discuss off-label prescribing.

3 Objectives Describe different types of dementias in which neuropsychiatric symptoms often occur State when and why the neuropsychiatric symptoms happen Name a common measurement tool used to classify and quantify neuropsychiatric symptoms Understand nonpharmacological approaches that should be tried prior to pharmacological treatment Discuss pharmacological treatments and research ongoing to find new therapies

4

5 types-of-dementia.asp

6 AD 5.5 million Americans of all ages have Alzheimer's 200,000 are YOUNGER than age 65 2/3 of Americans with Alzheimer's are women African-Americans are 2x as likely to have Alzheimer's Hispanics are 1.5x as likely to have Alzheimer's

7 CJD 1/1,000,000 cases diagnosed annually <1 year duration

8 FTD ~2/3 are years old 5-10/100,000 Behavior & personality changes early Some present with problems speaking

9 Parkinson s Disease Dementia & Dementia with Lewy Bodies Parkinson ds 1,000,000 in US 10/100,000 at age 50 & 200/100,000 at age 80 Dementia increases with age (65% by age 85) DLB 1,300,000 in US All have dementia

10 Wernicke-Korsakoff Syndrome Related to thiamine (B1) deficiency Alcohol abuse Malnutrition Gastric bypass Hyperemesis gravidarum AIDS

11 Huntington s Disease 1/10,000 in US Onset varies Childhood through late adulthood

12 In Alzheimer disease

13 Onset of Neuropsychiatric Symptoms Disease Early Middle Late Alzheimer x Parkinson disease x Dementia with Lewy Bodies x Frontotemporal disease BV x Frontotemporal disease LV x Frontotemporal disease MV x Creutzfeldt-Jakob disease x Wernicke-Korsakoff x Huntington disease x

14 Emergence of Neuropsychiatric Three phases: Symptoms (1) irritability, depression, and nighttime behavior changes; (2) anxiety, appetite changes, agitation, and apathy; and (3) elation, motor disturbances, hallucinations, delusions, and disinhibition Alzheimer s & Dementia: Translational Research & Clinical Interventions. September 2017; 3(3):

15

16 Antecedent Behavior Consequence (ABC) documentation The five Ws of behavior: a. What is the specific behavior? b. Why does this need to be addressed? c. Where does it occur? d. When does it occur? What occurred just before the behavior started? e. Who is around when it happens?

17 NPI-Q Link/CONT/A/CONT_21_3_2015_02_26_KAUFER_ _SDC2.pdf

18 Neurobiology

19

20 Classes of Medications Used Antidepressants Antidepressants target the symptoms of depression such as irritability, negativity, anxiety, resistance, agitation, sadness, sleep disturbance, expressions of worthlessness/desire to die, and appetite changes can even include paranoia and other forms of psychosis Mood Stabilizers Mood stabilizers are given to assist in management of mood, agitatio,n and aggression such as Depakote and Neurontin and Tegretol/Trileptal Anti-psychotic Medications Treat the extreme behavioral consequences of dementia They do have serious potential side effects including increased risk of death, increase in parkinsonism, and others First generation or typical antipsychotic medications should be used in low doses and short-term Second generation or atypical antipsychotic medications, such as Risperdal, Zyprexa and Seroquel are preferred is they must be used Newer, non-dopaminergeric targeting anti-psychotic medications, such as pimavanserin, is approved for use in Parkinson disease psychosis

21 Neuropsychiatric Symptoms Psychosis Depression & Apathy Agitation Sleep & Sundowning

22 Psychosis Occurs in older adults with Bipolar disorder Delirium, medications Major Depression Dementia Late-life delusional disorder Metabolic disorders Thyroid, glucose/sodium imbalance, B12/B1 deficiency Pain Schizophrenia Seizures, epilepsy Brain tumors or stroke Alcohol or drug withdrawal About 20%+ of Alzheimer s disease patients More in DLB Delusions may be paranoid People stealing things Spouse unfaithful Hallucinations (~11% of patients) are more commonly visual

23 Increased mortality has been identified with the use of all antipsychotic agents They carry an FDA warning regarding increased all cause mortality in patients with dementia (risk compared to placebo)(4.5% v 2.6% rate of death)(cv or infection)(risk may vary depending on dose)

24 Selective Serotonin (5-HT) 2A Receptor Inverse Agonist Pimavanserin FDA approved treatment for Parkinson s disease psychosis does not block dopamine D2 receptors

25 Mood Disorders: what & why Depression ~40% of AD, even MCI Sadness, loss of interest, anxiety, irritability, decreased appetite Consider social activities Could use antidepressants Watch for SSRI interactions with ACHEI More Common in PDD/DLB, esp with anxiety bvftd may be mistaken for depression initially Decreased serotonin, dopamine, NE?

26 Mood Disorders: what & why Apathy 36-88% of patients with AD; more common in FTD Impairs ADLs Types Affective: indifference or lack of empathy Behavioral: indolence and requirement for prompts to initiate physical activity Cognitive: inactivation of goal-directed cognitive activity Can coexist w/depression cortical dysfunction in the posterior cingulate or inferior temporal cortex; abnormalities in cholinergic, GABAergic, and dopaminergic function

27 Mood Disorders: treatment Depression in Alzheimer s Disease Study (DIADS) improvement with sertraline compared with placebo in patients with AD with major DIADS-2, included patients meeting criteria for depression of AD, but found no differences in depression outcomes Other studies included mirtazapine and SNRIs without improvement in outcome For apathy: Open label studies of cholinesterase inhibitors (donepezil, galantamine, and rivastigmine) showed improvement in apathy for all three medications For PDD, DLB, may need dopaminergic stimulation Treat co-existing depression ACHEI plus Alpha GPC

28 Agitation: what Defined as excessive motor activity, or verbal or physical aggression that is associated with emotional distress (1) severe enough to produce disability; (2) beyond what would be expected from cognitive impairment by itself; (3) not solely attributable to another disorder, environmental conditions, or the physiological effects of a substance Often associated with psychosis, anxiety, and disinhibition

29 Agitation: why Degeneration of the brain regions associated with emotional regulation and salience The frontal, anterior cingulate, and posterior cingulate cortices, amygdala, and hippocampus Decreased acetylcholine & serotonin Psychologically, reduced stress thresholds and unmet needs due to limited communication

30

31

32 Agitation: treatment Educate caregivers Change the physical environment Increase social engagement, exercise and activities Address sleep problems Assessing pain, discomfort, and other medical conditions SSRI, mood stabilizer, antipsychotic may help

33

34

35 Sundowning: what the exacerbation of cognitive symptoms and confusion anxiety, agitation, aggression, pacing, wandering, resistance, screaming, yelling, visual and auditory hallucinations the occurrence or worsening of behavioral disturbances during the late afternoon and early evening, whereas other researchers also consider NPS occurring throughout the night or more vaguely emerging with darkness Front. Med., 27 December 2016

36 Sundowning: why Circadian rhythm disorders involvement of the suprachiasmatic nucleus (SCN), located in the hypothalamus and considered as the major circadian pacemaker of the human body SCN is sensitive to cholinergic stimulation SCN regulates melatonin secretion

37

38

39 Sundowning: treatment

40 In Summary Exclude medical and environmental factors Non-pharmacological interventions should be attempted before moving to drug therapy Symptoms include depression or anxiety selective serotonin reuptake inhibitors, such as antidepressants, are advised Symptoms do not include depression or anxiety AChEIs are first recommended Then atypical antipsychotics Memantine may be helpful, also melatonin, mood stabilizers

41 Agitation in Dementia Research Studies Lithium Prazosin in NH residents* NUEDEXTA (dextromethorphan HBr and quinidine sulfate)

42

BEHAVIORAL PROBLEMS IN DEMENTIA

BEHAVIORAL 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 information

DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.

DEMENTIA 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 information

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, 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 information

Recognition and Management of Behavioral Disturbances in Dementia

Recognition and Management of Behavioral Disturbances in Dementia Recognition and Management of Behavioral Disturbances in Dementia Danielle Hansen, DO, MS (Med Ed), MHSA INTRODUCTION 80% 90% of patients with dementia develop at least one behavioral disturbances or psychotic

More information

Disclosure. Speaker Bureaus. Grant Support. Pfizer Forest Norvartis. Pan American Health Organization/WHO NIA HRSA

Disclosure. 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 information

GERIATRIC MENTAL HEALTH AND MEDICATION TREATMENT

GERIATRIC MENTAL HEALTH AND MEDICATION TREATMENT Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences GERIATRIC MENTAL HEALTH AND MEDICATION TREATMENT RUTH KOHEN ASSOCIATE PROFESSOR UW DEPARTMENT OF PSYCHIATRY 5-4-2017

More information

Management of Behavioral Problems in Dementia

Management of Behavioral Problems in Dementia Management of Behavioral Problems in Dementia Ghulam M. Surti, MD Clinical Assistant Professor Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Definition of

More information

BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS IN DEMENTIA

BEHAVIOURAL 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 information

HDSA welcomes you to Caregiver s Corner. Funded by an educational grant from

HDSA welcomes you to Caregiver s Corner. Funded by an educational grant from HDSA welcomes you to Caregiver s Corner Funded by an educational grant from Caregiver s Corner Webinar, DATE Managing Psychiatric Symptoms Peg Nopoulos, M.D. Professor of Psychiatry, Neurology, and Pediatrics

More information

Behavioral and Psychological Symptoms of dementia (BPSD)

Behavioral 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 information

Behavioral Issues in Dementia. March 27, 2014 Dylan Wint, M.D.

Behavioral Issues in Dementia. March 27, 2014 Dylan Wint, M.D. Behavioral Issues in Dementia March 27, 2014 Dylan Wint, M.D. OVERVIEW Key points Depression Definitions and detection Treatment Psychosis Definitions and detection Treatment Agitation SOME KEY POINTS

More information

Dementia ALI ABBAS ASGHAR-ALI, MD STAFF PSYCHIATRIST MICHAEL E. DEBAKEY VA MEDICAL CENTER ASSOCIATE PROFESSOR BAYLOR COLLEGE OF MEDICINE

Dementia ALI ABBAS ASGHAR-ALI, MD STAFF PSYCHIATRIST MICHAEL E. DEBAKEY VA MEDICAL CENTER ASSOCIATE PROFESSOR BAYLOR COLLEGE OF MEDICINE Dementia ALI ABBAS ASGHAR-ALI, MD STAFF PSYCHIATRIST MICHAEL E. DEBAKEY VA MEDICAL CENTER ASSOCIATE PROFESSOR BAYLOR COLLEGE OF MEDICINE Objectives At the conclusion of the session, participants will be

More information

40% of mild cognitive impairment 60% of patients in early stage of dementia

40% of mild cognitive impairment 60% of patients in early stage of dementia BPSD Vague and under-researched although described clearly by Alois Alzheimer Term ratified by 1996 IPA consensus conference Not fully recognised in current diagnostic systems Bypassed by dementia strategy

More information

Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults

Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults Cherie Simpson, PhD, APRN, CNS-BC Myth vs Fact All old people get depressed. Depression in late life is more enduring and

More information

ANTIPSYCHOTICS IN LONG TERM CARE: Are We Doing More Harm than Good?

ANTIPSYCHOTICS 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 information

Psychotropic Medication Use in Dementia

Psychotropic Medication Use in Dementia Psychotropic Medication Use in Dementia Marie A DeWitt, MD Diplomate of the American Board of Psychiatry and Neurology, Specialization in Psychiatry & Subspecialization in Geriatric Psychiatry Staff Physician,

More information

Neurocognitive Disorders Research to Emerging Therapies

Neurocognitive 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 information

GENI Jeopardy: Geriatric Mental Health. Part of the brain responsible for executive functioning

GENI Jeopardy: Geriatric Mental Health. Part of the brain responsible for executive functioning GENI Jeopardy: Geriatric Mental Health Part of the brain responsible for executive functioning Dementia: It is not just forgetfulness GENI February 20, 2008 Marcia Carr - CNS Dementia Dementia means brain

More information

Dementia and Fall Geriatric Interprofessional Training. Wael Hamade, MD, FAAFP

Dementia and Fall Geriatric Interprofessional Training. Wael Hamade, MD, FAAFP Dementia and Fall Geriatric Interprofessional Training Wael Hamade, MD, FAAFP Prevalence of Dementia Age range 65-74 5% % affected 75-84 15-25% 85 and older 36-50% 5.4 Million American have AD Dementia

More information

Addressing Difficult Behaviors in Dementia

Addressing Difficult Behaviors in Dementia Addressing Difficult Behaviors in Dementia GEORGE SCHOEPHOERSTER, MD GERIATRICIAN GENEVIVE/CENTRACARE CLINIC Objectives By the end of the session, you will be able to: 1) Explain the role of pain management

More information

Medications 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 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 information

Dementia: It s Not Always Alzheimer s

Dementia: It s Not Always Alzheimer s Dementia: It s Not Always Alzheimer s A Caregiver s Perspective Diane E. Vance, Ph.D. Mid-America Institute on Aging and Wellness 2017 My Background Caregiver for my husband who had Lewy Body Dementia

More information

Cognitive enhancers PINCH ME. Anticholinergic burden BPSD. Agitation, Aggression and antipsychotics

Cognitive 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 information

9/11/2012. Clare I. Hays, MD, CMD

9/11/2012. 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 information

Assessing and Managing the Patient with Cognitive Decline

Assessing and Managing the Patient with Cognitive Decline Assessing and Managing the Patient with Cognitive Decline Center of Excellence For Alzheimer s Disease for State of NY Capital Region Alzheimer s Center of Albany Medical Center Earl A. Zimmerman, MD Professor

More information

WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient

WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient DEMENTIA WHAT IS DEMENTIA? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient Progressive and disabling Not an inherent aspect of

More information

Antipsychotics for Dementia Under Control or Over-Prescribed?

Antipsychotics 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 information

Behavioral Management in Dementia. a.k.a. Public Enemy Number One a.k.a. Proteins Gone Bad

Behavioral Management in Dementia. a.k.a. Public Enemy Number One a.k.a. Proteins Gone Bad Behavioral Management in Dementia a.k.a. Public Enemy Number One a.k.a. Proteins Gone Bad Game Plan 1. Definition 2. Epidemiology 3. Assessment: IT S OVER 4. Nonpharmacologic Strategies: 4 S 5. Nonpharmacologic:

More information

HDSA Annual Convention June 2013 Behavior Issues: Irritability and Depression Peg Nopoulos, M.D.

HDSA Annual Convention June 2013 Behavior Issues: Irritability and Depression Peg Nopoulos, M.D. HDSA Annual Convention June 2013 Behavior Issues: Irritability and Depression Peg Nopoulos, M.D. Professor of Psychiatry, Neurology, and Pediatrics University of Iowa, Iowa City, Iowa The information provided

More information

What is dementia? alzheimers.org.uk

What is dementia? alzheimers.org.uk alzheimers.org.uk What is dementia? If you, or a friend or relative, have been diagnosed with dementia, you may be feeling anxious or confused. You may not know what dementia is. This factsheet should

More information

Assessment and management of behavioral and psychological symptoms of dementia

Assessment 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 information

DEMENTIA AND MEDICATION

DEMENTIA 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 information

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 (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 information

Parkinson s Disease Psychosis Treatment in Long-Term Care: Clinical and Operational Considerations

Parkinson s Disease Psychosis Treatment in Long-Term Care: Clinical and Operational Considerations Parkinson s Disease Psychosis Treatment in Long-Term Care: Clinical and Operational Considerations Pari Deshmukh MD Triple board-certified psychiatrist (Boards of psychiatry, addiction medicine, integrative

More information

Corporate Presentation August 6, 2015

Corporate Presentation August 6, 2015 Corporate Presentation August 6, 2015 Creating the Next Generation of CNS Drugs Forward-Looking Statement This presentation contains forward-looking statements. These statements relate to future events

More information

Parkinsonian Disorders with Dementia

Parkinsonian Disorders with Dementia Parkinsonian Disorders with Dementia George Tadros Consultant in Old Age Liaison Psychiatry, RAID, Heartlands Hospital Professor of Dementia and Liaison Psychiatry, Aston Medical School Aston University

More information

Mental Health Disorders Civil Commitment UNC School of Government

Mental Health Disorders Civil Commitment UNC School of Government Mental Health Disorders 2017 Civil Commitment UNC School of Government Edward Poa, MD, FAPA Chief of Inpatient Services, The Menninger Clinic Associate Professor, Baylor College of Medicine NC statutes

More information

ALZHEIMER S DISEASE. Mary-Letitia Timiras M.D. Overlook Hospital Summit, New Jersey

ALZHEIMER S DISEASE. Mary-Letitia Timiras M.D. Overlook Hospital Summit, New Jersey ALZHEIMER S DISEASE Mary-Letitia Timiras M.D. Overlook Hospital Summit, New Jersey Topics Covered Demography Clinical manifestations Pathophysiology Diagnosis Treatment Future trends Prevalence and Impact

More information

Understanding Dementia

Understanding Dementia Dementia Handbook for Carers Essex Understanding Dementia What is dementia? 1 Summary of dementia symptoms 4 Medication and treatment 5 1 Dementia is the name for several conditions that lead to the progressive

More information

Use of Psychotropic Medications in Older Adults with Dementia!

Use of Psychotropic Medications in Older Adults with Dementia! Use of Psychotropic Medications in Older Adults with Dementia! Deepa Pattani, PharmD, RPh Owner: PrevInteract Health Deepa.Pattani@PrevInteract.com 972-372-9775 About Me Deepa Pattani, PharmD, RPh with

More information

Vanderbilt & atom Alliance Webinar Series

Vanderbilt & atom Alliance Webinar Series Vanderbilt & atom Alliance Webinar Series Vanderbilt University Medical Center Vanderbilt University Center for Quality Aging atom Alliance Session #2: Dementia & Behavioral Disturbances Session #3: Psychopharmacology

More information

Drugs used to relieve behavioural and psychological symptoms in dementia

Drugs used to relieve behavioural and psychological symptoms in dementia alzheimers.org.uk Drugs used to relieve behavioural and psychological symptoms in dementia People with dementia may develop behavioural and psychological symptoms including restlessness, aggression, delusions,

More information

Chapter 15: Late Life and Psychological Disorders

Chapter 15: Late Life and Psychological Disorders \ Chapter 15: Late Life and Psychological Disorders 1. Ageism refers to a. the physical deterioration that accompanies old age. b. the intellectual deterioration that frequently occurs as a person ages.

More information

The place for treatments of associated neuropsychiatric and other symptoms

The 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 information

Lewy Body Disease. Dementia Education for the First Responder July 27, 2017

Lewy Body Disease. Dementia Education for the First Responder July 27, 2017 Lewy Body Disease Dementia Education for the First Responder July 27, 2017 Dylan Wint, M.D. NV Energy Chair for Brain Health Education Cleveland Clinic Lou Ruvo Center for Brain Health OUTLINE Lewy body

More information

Rational Medication Use in Dementia

Rational 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 information

Management of Behavioral Symptoms in Dementia. Brenda Jordan, MS, ARNP, BC- PCM Dartmouth-Hitchcock Kendal

Management of Behavioral Symptoms in Dementia. Brenda Jordan, MS, ARNP, BC- PCM Dartmouth-Hitchcock Kendal Management of Behavioral Symptoms in Dementia Brenda Jordan, MS, ARNP, BC- PCM Dartmouth-Hitchcock Kendal Behavioral Symptoms Common & troubling At least one will occur in 61-92% of those with any dementia

More information

Non Alzheimer Dementias

Non Alzheimer Dementias Non Alzheimer Dementias Randolph B Schiffer Department of Neuropsychiatry and Behavioral Science Texas Tech University Health Sciences Center 9/11/2007 Statement of Financial Disclosure Randolph B Schiffer,,

More information

Greg Jicha, M.D., Ph.D. Associate Professor of Neurology The Robert T. & Nyles Y. McCowan Chair in Alzheimer s Research University of Kentucky

Greg Jicha, M.D., Ph.D. Associate Professor of Neurology The Robert T. & Nyles Y. McCowan Chair in Alzheimer s Research University of Kentucky Greg Jicha, M.D., Ph.D. Associate Professor of Neurology The Robert T. & Nyles Y. McCowan Chair in Alzheimer s Research University of Kentucky Alzheimer s Disease Center and the Sanders-Brown Center on

More information

Diagnosis and Treatment of Alzhiemer s Disease

Diagnosis 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 information

Diagnosis and management of non-alzheimer dementias. Melissa Yu, M.D. Department of Neurology

Diagnosis and management of non-alzheimer dementias. Melissa Yu, M.D. Department of Neurology Diagnosis and management of non-alzheimer dementias Melissa Yu, M.D. Department of Neurology AGENDA Introduction When to think of alternate diagnoses Other forms of dementia Other reasons for confusion

More information

Reality, as perceived by the patient, constitutes the reality of the situation. My Mother s Doing What???!!

Reality, as perceived by the patient, constitutes the reality of the situation. My Mother s Doing What???!! My Mother s Doing What???!! Management & Treatment of Dementia Related Behaviors Objectives Describe the prevalence, etiology of dementia related behaviors that include physical outbursts & sexual hyperactivity.

More information

WHEN THE GOING GETS TOUGH: Working Through the Challenges of Dementia Together. Presented by

WHEN THE GOING GETS TOUGH: Working Through the Challenges of Dementia Together. Presented by WHEN THE GOING GETS TOUGH: Working Through the Challenges of Dementia Together Presented by Our agenda for today Understanding behavioral symptoms in people living with dementia Briefly review key strategies

More information

Pharmacological Treatment of Aggression in the Elderly

Pharmacological 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 information

The Psychopharmacology of Alzheimer s Disease. Bruce Kaster, MD Instructor in Psychiatry Harvard Medical school

The Psychopharmacology of Alzheimer s Disease. Bruce Kaster, MD Instructor in Psychiatry Harvard Medical school The Psychopharmacology of Alzheimer s Disease Bruce Kaster, MD Instructor in Psychiatry Harvard Medical school Overview of Alzheimer s Disease Alzheimer s is a progressive degenerative disease Prevalence

More information

Debra 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 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 information

7/3/2013 ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER FOURTEEN CHAPTER OUTLINE. Dementia, Delirium, and Amnestic Disorders. Oltmanns and Emery

7/3/2013 ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER FOURTEEN CHAPTER OUTLINE. Dementia, Delirium, and Amnestic Disorders. Oltmanns and Emery ABNORMAL PSYCHOLOGY SEVENTH EDITION Oltmanns and Emery PowerPoint Presentations Prepared by: Ashlea R. Smith, Ph.D. This multimedia and its contents are protected under copyright law. The following are

More information

Alzheimer s Disease. Pathophysiology: Alzheimer s disease (AD) is a progressive dementia affecting cognition, behavior,

Alzheimer s Disease. Pathophysiology: Alzheimer s disease (AD) is a progressive dementia affecting cognition, behavior, 2 Alzheimer s Disease Alzheimer s disease (AD) is a progressive dementia affecting cognition, behavior, and functional status with no known cause or cure. Patients eventually lose cognitive, analytical,

More information

Psychotropic Medication. Including Role of Gradual Dose Reductions

Psychotropic 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 information

PSYCHIATRIC SYNDROMES OF OLDER ADULTS

PSYCHIATRIC SYNDROMES OF OLDER ADULTS PSYCHIATRIC SYNDROMES OF OLDER ADULTS MARTIN FREIMER MD U OF U CENTER FOR ALZHEIMER S CARE, IMAGING AND RESEARCH DEPARTMENT OF PSYCHIATRY UNIVERSITY OF UTAH INTRODUCTION TO NEUROCOGNITIVE DISORDERS POTENTIAL

More information

Screening and Management of Behavioral and Psychiatric Symptoms Associated with Dementia

Screening and Management of Behavioral and Psychiatric Symptoms Associated with Dementia Screening and Management of Behavioral and Psychiatric Symptoms Associated with Dementia Measure Description Percentage of patients with dementia for whom there was a documented screening* for behavioral

More information

What is dementia? Symptoms. alzheimers.org.uk

What is dementia? Symptoms. alzheimers.org.uk alzheimers.org.uk What is dementia? This factsheet explains what dementia is, including the causes and symptoms, and how it is diagnosed and treated. It also looks at some of the different types of dementia.

More information

노인병원에서 Light Therapy 의 활용 박 기 형 진주삼성병원 송도병원 신경과

노인병원에서 Light Therapy 의 활용 박 기 형 진주삼성병원 송도병원 신경과 Light Therapy 1 : 15 / 63 (23.8%) 1 : 7 2 : 8 : 6 / 86 (7%) 1, : 48 / 205 (23.4%) 1 : 43 2 : 5 Sleep in Geriatrics Prevalence NIH survey of 9000 american senior above age 65 ; 88% had sleep disturbances

More information

Presenter Disclosure Information 3:45 4:45pm The following relationships exist related to this presentation: Strategies for Optimizing

Presenter Disclosure Information 3:45 4:45pm The following relationships exist related to this presentation: Strategies for Optimizing 3:45 4:45pm Strategies for Optimizing Dementia Care for Patients and Caregivers SPEAKER Elizabeth Crocco, MD Presenter Disclosure Information The following relationships exist related to this presentation:

More information

Understanding dementia

Understanding dementia Dementia handbook for carers Essex Understanding dementia About this handbook 1 What is dementia 3 Summary of dementia symptoms 6 Medication and treatment 7 About this handbook This handbook aims to summarise

More information

Management of the Acutely Agitated Long Term Care Patient

Management 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 information

DRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future

DRUG 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 information

Psychopathology: Biological Basis of Behavioral Disorders

Psychopathology: Biological Basis of Behavioral Disorders 1 6 Psychopathology: Biological Basis of Behavioral Disorders 16 Psychopathology: Biological Basis of Behavioral Disorders The Toll of Psychiatric Disorders Is Huge Schizophrenia is the major neurobiological

More information

Dementia. Assessing Brain Damage. Mental Status Examination

Dementia. Assessing Brain Damage. Mental Status Examination Dementia Assessing Brain Damage Mental status examination Information about current behavior and thought including orientation to reality, memory, and ability to follow instructions Neuropsychological

More information

The Basics of Alzheimer s Disease

The Basics of Alzheimer s Disease 2017 Memory Loss Conference The Basics of Alzheimer s Disease Tom Ala, MD Center for Alzheimer s Disease and Related Disorders Southern Illinois University School of Medicine Springfield, Illinois SIU

More information

Differentiating Dementia Diagnoses

Differentiating Dementia Diagnoses Differentiating Dementia Diagnoses Waitemata PHO 21 October 2014 Dr Michal Boyd, RN, NP, ND Nurse Practitioner Older Adults School of Nursing & Freemasons Dept. of Geriatric Medicine The University of

More information

Dementia: Managing Difficult Behaviors. No conflicts of interest. Off-label medication use will be discussed during this talk.

Dementia: Managing Difficult Behaviors. No conflicts of interest. Off-label medication use will be discussed during this talk. Dementia: Managing Difficult Behaviors No conflicts of interest. Off-label medication use will be discussed during this talk. 1 Types of Neurocognitive Disorder Alzheimer s Disease Vascular Frontotemporal

More information

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines

More information

Dementia Diagnosis Guidelines Primary Care

Dementia Diagnosis Guidelines Primary Care Dementia Diagnosis Guidelines Primary Care Dementia Diagnosis Primary Care Guidelines Introduction Dementia is a long term condition, which primarily affects people over the age of 65 (late on-set dementia)

More information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process Quality ID #283: Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY

More information

Contemporary Psychiatric-Mental Health Nursing. Psychopharmacology. Psychopharmacology - continued. Chapter 7 The Science of Psychopharmacology

Contemporary Psychiatric-Mental Health Nursing. Psychopharmacology. Psychopharmacology - continued. Chapter 7 The Science of Psychopharmacology Contemporary Psychiatric-Mental Health Nursing Chapter 7 The Science of Psychopharmacology Psychopharmacology A primary treatment mode of psychiatric-mental health nursing care Psychopharmacology - continued

More information

Pharmacological 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 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 information

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally

More information

Impact of Psychotropics in School

Impact of Psychotropics in School Impact of Psychotropics in School H O W T O C O O R D I N A T E C A R E A C R O S S S E T T I N G S W I L L I A M P U G A, M D C H I L D A N D A D O L E S C E N T P S Y C H I A T R I S T Age of onset

More information

Parkinson s Disease Psychosis: Hallucinations Delusions and Paranoia

Parkinson s Disease Psychosis: Hallucinations Delusions and Paranoia Parkinson s Disease Psychosis: Hallucinations Delusions and Paranoia Christopher G. Goetz, MD Professor of Neurological Sciences Professor of Pharmacology Rush University Medical Center Parkinson s Foundation

More information

Behavioural and Psychological Symptoms of Dementia (BPSD) in Primary Care

Behavioural and Psychological Symptoms of Dementia (BPSD) in Primary Care Behavioural and Psychological Symptoms of Dementia (BPSD) in Primary Care Dr. John Puxty Ontario s Ontario s Strategy Strategy for Alzheimer for Disease and Related Dementia: Initiative #2, #2, Physician

More information

Medication Treatment of Cognitive and Behavioral Symptoms in Dementia

Medication Treatment of Cognitive and Behavioral Symptoms in Dementia Medication Treatment of Cognitive and Behavioral Symptoms in Dementia Cary J. Kohlenberg, M.D. Medical Director, IPC Research and Independent Psychiatric Consultants Environmental interventions directly

More information

6/22/2012. Co-morbidity - when two or more conditions occur together. The two conditions may or may not be causally related.

6/22/2012. Co-morbidity - when two or more conditions occur together. The two conditions may or may not be causally related. Autism Spectrum Disorders and Co-existing Mental Health Issues By Dr. Karen Berkman Objective To present an overview of common psychiatric conditions that occur in persons with autism spectrum disorders

More information

Pediatric Psychopharmacology

Pediatric Psychopharmacology Pediatric Psychopharmacology General issues to consider. Pharmacokinetic differences Availability of Clinical Data Psychiatric Disorders can be common in childhood. Early intervention may prevent disorders

More information

USING 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? 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 information

Behavior Problems: in Long Term Care and Assisted Living

Behavior Problems: in Long Term Care and Assisted Living Behavior Problems: Dementia and Mental Illness in Long Term Care and Assisted Living Module I Dr. David A. Smith, M.D., FAAFP, CMD mmlearn.org is a program of Morningside Ministries Cell Phones and Pagers

More information

OLD AGE PSYCHIATRY. Dementia definition TYPES OF DEMENTIA. Other causes. Psychiatric disorders of the elderly. Dementia.

OLD AGE PSYCHIATRY. Dementia definition TYPES OF DEMENTIA. Other causes. Psychiatric disorders of the elderly. Dementia. Psychiatric disorders of the elderly OLD AGE PSYCHIATRY Dementia Depression Delusional disorder/late onset schizophrenia Delirium Dementia definition LOCALISATION OF CEREBRAL FUNCTION Impairment of multiple

More information

Dementia, Depression, and Delirium 2.0 Contact Hours Presented by: CEU Professor

Dementia, Depression, and Delirium 2.0 Contact Hours Presented by: CEU Professor Dementia, Depression, and Delirium 2.0 Contact Hours Presented by: CEU Professor 7 www.ceuprofessoronline.com Copyright 8 2008 The Magellan Group, LLC All Rights Reserved. Reproduction and distribution

More information

Dr Georgina Train Consultant Psychiatrist EMDASS service and Continuing Care.

Dr Georgina Train Consultant Psychiatrist EMDASS service and Continuing Care. Dr Georgina Train Consultant Psychiatrist EMDASS service and Continuing Care. Consultant Psychiatrist of both General adult and Old Age Psychiatry. Work with Memory Service and a Continuing Care ward.

More information

MODULE III Challenging Behaviors

MODULE III Challenging Behaviors Mental Health Ombudsman Training Manual Advocacy and the Adult Home Resident MODULE III Challenging Behaviors S WEHRY 2004 Objectives: Part One Describe principles of communication Describe behavior as

More information

How Aging and Dementia Effect Resident Behaviors

How Aging and Dementia Effect Resident Behaviors How Aging and Dementia Effect Resident Behaviors November 3, 2011 1:00 2:00 PM EST Webinar Presented by: Alfred W. Norwood, BS, MBA Education Arm of the Carmelite Sisters for the Aged and Infirm Webinar

More information

Overview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits

Overview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits Overview Overview Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits The differential diagnosis of Parkinson s disease Primary vs. Secondary Parkinsonism Proteinopathies:

More information

Pharmacological Management of Dementia-Related Behaviors

Pharmacological Management of Dementia-Related Behaviors Welcomes You To Pharmacological Management of Dementia-Related Behaviors Presented by Brett Lu, MD, PhD Associate Professor of Psychiatry John A. Burns School of Medicine September 5, 2017 10:00 11:00

More information

2/9/2018. Certificate of Completion: Pharmacological Management of Dementia Related Behaviors. Welcomes You To

2/9/2018. Certificate of Completion: Pharmacological Management of Dementia Related Behaviors. Welcomes You To Welcomes You To Pharmacological Management of Dementia Related Behaviors Presented by Brett Lu, MD, PhD Associate Professor of Psychiatry John A. Burns School of Medicine September 5, 2017 10:00 11:00

More information

PROJECTION: Worlds dementia population is expected to triple by 2050

PROJECTION: Worlds dementia population is expected to triple by 2050 DEMENTIA C L I S K C O N S U LTA N T P H Y S I C I A N I N A C U T E M E D I C I N E A N D G E R I AT R I C M E D I C I N E, B A R N E T H O S P I TA L, R O YA L F R E E N H S F O U N D AT I O N T R U

More information

REVERSIBLE DEMENTIAS. Drug/alcohol interactions Thyroid disease Tumors Malnutrition/dehydration Infections Anemia Mental Illness

REVERSIBLE DEMENTIAS. Drug/alcohol interactions Thyroid disease Tumors Malnutrition/dehydration Infections Anemia Mental Illness DEMENTIA Dementia describes a group of symptoms that are caused by changes in brain function. People with dementia lose their abilities at different rates depending on the disease causing the symptoms.

More information

Dementia Basics. Welcome! What to expect and how to handle a dementia diagnosis. In partnership with Scripps Health.

Dementia Basics. Welcome! What to expect and how to handle a dementia diagnosis. In partnership with Scripps Health. Dementia Basics What to expect and how to handle a dementia diagnosis March 18, 2017 In partnership with Scripps Health Welcome! 1 Welcome Kristin Gaspar San Diego County Supervisor District 3 2 Our Mission:

More information

OBJECTIVES DEMENTIA, DELIRIUM, DEPRESSION DEMENTIA

OBJECTIVES DEMENTIA, DELIRIUM, DEPRESSION DEMENTIA OBJECTIVES DEMENTIA, DELIRIUM, DEPRESSION Carol Herzberg, R.N., BSN Health Care Consultant Differentiate between normal age related cognitive decline, mild cognitive impairment and dementia Differentiate

More information

11/11/2016. Disclosures. Natural history of BPSD. Objectives. Assessment of BPSD. Behavioral Management of Persons with Alzheimer s Disease

11/11/2016. 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 information

Managing agitation in dementia using non-pharmacological therapies

Managing agitation in dementia using non-pharmacological therapies Managing agitation in dementia using non-pharmacological therapies Gill Livingston Lynsey Kelly, Elanor Lewis-Holmes, Gianluca Baio, Rumana Omar, Stephen Morris, Nishma Patel, Cornelius Katona, Claudia

More information