ABSTRACT
Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.
Sintomas neuropsiquiátricos ou comportamentais de demência envolvem uma série de condições, como ansiedade, depressão, apatia, psicose e agitação, frequentemente observadas em indivíduos com demência. Embora esses sintomas não sejam necessários para o diagnóstico da doença de Alzheimer, estão presentes em todas as fases ou estágios da doença, contribuindo negativamente para o declínio cognitivo, comprometimento funcional e sobrecarga do cuidador. Os sintomas neuropsiquiátricos têm sido conceituados não apenas como fatores de risco, mas também como marcadores clínicos de progressão da doença de Alzheimer. O construto "comprometimento comportamental leve", correlato comportamental do comprometimento cognitive leve, tem sido proposto nesse contexto. Os primeiros passos na abordagem dos sintomas comportamentais da doença de Alzheimer envolvem definir os alvos-terapêuticos e investigar potenciais causas ou fatores agravantes. Após intervir nesses fatores, abordagens não farmacológicas constituem a primeira linha de intervenção. Depois da otimização do tratamento anticolinesterásico, terapias farmacológicas específicas (por exemplo, antidepressivos, antipsicóticos) podem ser consideradas, levando-se em conta potencias efeitos colaterais.
Subject(s)
Alzheimer Disease , Antipsychotic Agents , Cognitive Dysfunction , Mental Disorders , Humans , Alzheimer Disease/psychology , Mental Disorders/drug therapy , Mental Disorders/etiology , Antipsychotic Agents/therapeutic use , Cognitive Dysfunction/psychology , Anxiety , Behavioral Symptoms/drug therapy , Behavioral Symptoms/etiologyABSTRACT
HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Behavioral Symptoms/etiology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/psychology , Adult , Antipsychotic Agents/therapeutic use , Behavioral Symptoms/drug therapy , Behavioral Symptoms/psychology , Disease Progression , Follow-Up Studies , HIV , Humans , Male , Risk FactorsABSTRACT
HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident
La infección del VIH continúa siendo un importante problema de salud en la región del Caribe. Con la disponibilidad de tratamiento de droga de antiretroviral, está poniéndose en aumento importante para identificar los marcadores clínicos para el deterioración de la infección enfermar. Se reconocen bien los síntomas psiquiátricos como una complicación de infección por VIH. Sin embargo, se presentan tres casos para sugerir que específicamente la manifestación de manía relacionada con el VIH puede tener importancia clínica en anunciar la transición de la infección por VIH a SIDA. Esto tiene relevancia en cuanto a evaluar el curso del trastorno y podría indicar que la manifestación psiquiátrica de infección neurotrópica representa un marcador distintivo para el diagnóstico del SIDA, quizás antes de que cualquier otra señal clínica se haga evidente.