Cognitive intervention therapy as treatment for behaviour disorders in Alzheimer disease: evidence on efficacy and neurobiological correlations.

INTRODUCTION: The prevalence of behavioural and psychological symptoms (BPS) is very high among patients with Alzheimer disease (AD); more than 90% of AD patients will present such symptoms during the course of the disease. These symptoms result in poorer quality of life for both patients and caregivers and increased healthcare costs. BPS are the main factors involved in increases to the caregiver burden, and they often precipitate the admission of patients to residential care centres. DEVELOPMENT: Current consensus holds that intervention models combining pharmacological and non-pharmacological treatments are the most effective for AD patients. Several studies have shown cholinesterase inhibitors and memantine combined with cognitive intervention therapy (CIT) to be effective for improving patients' cognitive function and functional capacity for undertaking daily life activities. However, the efficacy of CIT as a treatment for BPS has not yet been clearly established, which limits its use for this purpose in clinical practice. The objective of this review is to gather available evidence on the efficacy of cognitive intervention therapy (CIT) on BPS in patients with AD. CONCLUSIONS: The results of this review suggest that CIT may have a beneficial effect on BPS in patients with AD and should therefore be considered a treatment option for patients with AD and BPS.

[Neuropsychiatric and behavioral symptomatology in Alzheimer disease]. / Sintomatología neuropsiquiátrica y conductual en la enfermedad de Alzheimer.

Patients with Alzheimer's disease (AD) show high incidence of behavioral and psychological symptoms (BPS).The occurrence of BPS has a great impact on the patients and caregiver's quality of life, increases caregiver's burden, and in many cases precipitates admission of the patients to a geriatric center. On the other hand, the importance of the BPS is increasing because most of them are susceptible to being treated effectively, mainly thanks to the use of drug measures and behaviour modification techniques. This study describes the pathophysiological mechanisms of BPS in AD and its relationship with cognitive and functional impairment of patient and caregiver's burden and current therapies.

Sintomatología neuropsiquiátrica y conductual en la enfermedad de Alzheimer / Neuropsychiatric and behavioral symptomatology in Alzheimer’s disease

Los síntomas conductuales y psicológicos están presentes en la mayoría de los pacientes con enfermedad de Alzheimer y contribuyen de manera muy significativa al aumento de los costes asistenciales, a la pérdida de calidad de vida tanto del paciente como del cuidador y al incremento en éste de los niveles de carga y sufrimiento, a la vez que se constituyen como los principales predictores de institucionalización prematura del enfermo. Su importancia se ve incrementada porque la mayoría de ellos son susceptibles de ser tratados de manera eficaz gracias al empleo de medidas farmacológicas y de técnicas de modificación de conducta. En el presente trabajo se discuten sus posibles causas fisiopatológicas, así como su relación con el deterioro cognitivo y funcional del paciente, su influencia en la carga del cuidador y las opciones terapéuticas disponibles actualmente (AU)

Patients with Alzheimer´s disease (AD) show high incidence of behavioral and psychological symptoms (BPS).The occurrence of BPS have a great impact on the patients and caregiver´s quality of life, increase caregiver´s burden, and in many cases precipitates admission of the patients to a geriatric center. On the other hand, the importance of the BPS is increasing because most of them are susceptible to being treated effectively, mainly thanks to the use of drug measures and behaviour modification techniques. This study to describe the mechanisms pathophysiological of BPS in AD and its relationship with cognitive and functional impairment of patient and caregiver´s burden and current therapies (AU)

Prevalencia y comorbilidad de síntomas neuropsiquiátricos en la enfermedad de Alzheimer / Prevalence and comorbidity of neuropsychiatric symptoms in Alzheimer's disease

Introducción. Se describe la frecuencia y gravedad de los síntomas conductuales y psicológicos (SCP) en un grupo de125 pacientes diagnosticados con enfermedad de Alzheimer(EA) siguiendo criterios diagnósticos DSM-IV-TR y NINCDSADRDA. Metodología. La evaluación de los SCP se realizó mediante el Neuropsychiatric Inventory (NPI; Cummings et al., 1994). Se recogieron los datos sociodemográficos y antecedentes personales de los pacientes y se estableció el estadio de la demencia mediante la Global Deterioration Scale (GDS; Reisberg, 1982). Resultados. Un total de 122 pacientes (98%) presentaron SCP, con una media de cinco síntomas por paciente. La frecuencia de su presentación fue la siguiente: apatía (75%), irritabilidad (66%), depresión (60%), agitación (55%), ansiedad (54%), actividad motora aberrante (47%), delirios (38%), alteraciones del sueño (36 %), desinhibición (29 %), alteraciones del apetito (28%), alucinaciones (20%) y euforia (4%). Conclusiones. Estos resultados demuestran la alta incidencia de los SCP en los pacientes con EA y muestran la necesidad e importancia de tratar adecuadamente estas alteraciones (AU)

Introduction. The objective of this study is to describe the frequency and severity of behavioral and psychological symptoms (BPS) in a group of 125 patients diagnosed of Alzheimer’s disease (AD) (DSM-IV-TR and NINCDSADRDA criteria). Methods. The evaluation of the BPS was carried out using the Neuropsychiatric Inventory (NPI; Cummings et al., 1994). The sociodemographic and personal background data of the patients were gathered and the dementia stage was established with the Global Deterioration Scale (GDS Reisberg, 1982). Results. A total of 122 patients (98%) presented BPS, with an average of five symptoms per patient. Frequency of presentation was the following: apathy (75%), irritability (66 %), depression (60 %), agitation (55 %), anxiety (54 %), aberrant motor activity (47 %), delirium (38 %), sleeping disorders (36%), disinhibition (29%), eating disorders (28%), hallucinations (20%) and euphoria (4%). Conclusions. These results show the high incidence of BPS in AD patients and point to the necessity and importance of treating these disorders appropriately (AU)

Perfil clínico de pacientes con enfermedad de Alzheimer atendidos en centros de día psicogeriátricos / Clinical profile of patients with Alzheimer´s disease attended at psychogeriatric day centers

Objetivo: Describir las características sociodemográficas,perfil cognitivo, estado funcional y síntomas conductualesy psicológicos (SCP) en 125 pacientes conenfermedad de Alzheimer (EA), así como la carga desus cuidadores.Material y métodos: Se recogieron datos sociodemográficosy clínicos y se evaluaron: estadio de la demencia(Global Deterioration Scale), cognición (Mini Mental StateExamination/MMSE, Fluencia Verbal Semántica yFonológica, Rey Auditory Verbal Learning Test y TrailMaking Test), estado funcional (Bayer Activities of DailyLiving/B-ADL), SCP (Neuropsychiatric Inventory) y cargadel cuidador (atención a las actividades básicas de la vidadiaria/ABVD, Hamilton Depression Rating Scale/HDRS,State-Trait Inventory/STAI y subescala de sufrimiento delNeuropsychiatric Inventory).Resultados: El 70%de los pacientes eran mujeres (edadmedia: 76 años), con un tiempo de evolución de la demenciade 62 meses. Sufrían un deterioro cognitivo moderado(MMSE: 14,46 ± 4,81), un deterioro funcional moderado/grave (B-ADL: 8,92 ± 1,31). El 98% presentaron SCP.El 79% de los cuidadores fueron mujeres (edad media: 61años), dedicaban 2,34 ± 1,61 horas diarias a la atención deABVD. Presentaban niveles elevados de ansiedad (STAI:35,59 ± 7,05) y depresión (HDRS: 14,28 ± 6,66).Conclusiones: Nuestros resultados indican que lospacientes con EA atendidos en centros de día psicogeriátricosson mayoritariamente mujeres, con un deteriorocognitivo y funcional moderadamente graves y conuna elevada frecuencia de SCP. Sus cuidadores principalespresentan síntomas de ansiedad y depresión

Objective: The objective of this study is to describethe socio-demographic data, cognitive profile, functionalstatus and behavioral and psychological symptoms(BPS) in a group of 125 patients diagnosed withAlzheimer’s disease (AD), as also the burden and distressof their caregivers.Material and methods:We collected socio-demographicand clinical data and assessment: stage of dementia(Global Deterioration Scale), cognitive functions (MiniMental State Examination/MMSE, Semantic and PhonemicVerbal Fluency, Rey Auditory Verbal Learning Testand Trail Making Test), activities of daily living (BayerActivities of Daily Living/B-ADL), BPS (NeuropsychiatricInventory) and caregiver’s burden (number of hoursof attention given to the basic activities of dailyliving/BADL, Hamilton Depression Rating Scale/HDRS,State-Trait Inventory /STAI and NPI-distress Scale).Results: 70% of patients were women (mean age: 76years old), with a mean time of dementia of 62 months.They had a moderate cognitive impairment (MMSE:14.46 ± 4.81) and a severe functional deterioration (BADL:8.92 ± 1.31). A total of 122 patients (98%)showed BPS. 79% of caregiver were women (mean age:61 years old), dedicating an average of 2.34 hours toattend to the BADL, with a high level of anxiety (STAIE:35.59 ± 7.05) and depression (HDRS: 14.28 ± 6.66).Conclusions: The AD patients who attend the psychogeriatricday centers are mainly women, with moderatelysevere cognitive and functional impairment andwith high frequency of BPS. Their main caregiversshow symptoms of anxiety and depression

[Prevalence and comorbidity of neuropsychiatric symptoms in Alzheimer's disease]. / Prevalencia y comorbilidad de síntomas neuropsiquiátricos en la enfermedadde Alzheimer.

INTRODUCTION: The objective of this study is to describe the frequency and severity of behavioral and psychological symptoms (BPS) in a group of 125 patients diagnosed of Alzheimer's disease (AD) (DSM-IV-TR and NINCDSADRDA criteria). METHODS: The evaluation of the BPS was carried out using the Neuropsychiatric Inventory (NPI; Cummings et al., 1994). The sociodemographic and personal background data of the patients were gathered and the dementia stage was established with the Global Deterioration Scale (GDS Reisberg, 1982). RESULTS: A total of 122 patients (98%) presented BPS, with an average of five symptoms per patient. Frequency of presentation was the following: apathy (75%), irritability (66%), depression (60%), agitation (55%), anxiety (54%), aberrant motor activity (47%), delirium (38%), sleeping disorders (36%), disinhibition (29%), eating disorders (28%), hallucinations (20%) and euphoria (4%). CONCLUSIONS: These results show the high incidence of BPS in AD patients and point to the necessity and importance of treating these disorders appropriately.