New treatments in sight for challenging neuropsychiatric symptoms in neurodegenerative diseases

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In a caller study published successful nan diary JAMA Neurology, researchers reviewed nan advancement frankincense acold successful pharmacologically managing nan various neuropsychiatric syndromes that manifest successful neurodegenerative disorders and discussed nan caller advances successful knowing nan pathobiology of neurodegenerative disorders that thief amended objective attraction and therapy.

 PopTika / ShutterstockStudy: Progress successful Pharmacologic Management of Neuropsychiatric Syndromes successful Neurodegenerative Disorders. Image Credit: PopTika / Shutterstock

Neurodegenerative disorders and neuropsychiatric syndromes

Neurodegenerative disorders encompass a wide scope of conditions, galore of which are a facet of progressing property and manifest symptoms only successful precocious mediate property aliases aged age. However, pinch nan increasing aging organization successful nan world, nan wave of neurodegenerative disorders and associated conditions continues to increase. While Lewy assemblage dementia, Parkinson's disease, Huntington's disease, and Alzheimer's illness are immoderate of nan much commonly heard neurodegenerative disorders, others see frontotemporal dementia, corticobasal syndrome, progressive supranuclear palsy, amyotrophic lateral sclerosis, chronic traumatic encephalopathy, traumatic encephalopathy syndrome, and aggregate strategy atrophy.

All neurodegenerative disorders are associated pinch neuropsychiatric syndromes, pinch neuropsychiatric syndromes being portion of nan diagnostic criteria for immoderate of nan neurodegenerative disorders. These neuropsychiatric syndromes tin hap sequentially aliases simultaneously and play a awesome domiciled successful functional impairment and wide diminution successful value of life, not to mention adding to caregiver distress.

Non-pharmacological interventions specified arsenic psychosocial treatments person been extensively explored to ameliorate neuropsychiatric syndromes successful cases of neurodegenerative disorders and to forestall relapse. These see workout programs, biology modifications, music, acupressure and massage therapy, activities specified arsenic creation successful operation pinch music, and animal-assisted interventions.

However, successful cases wherever psychosocial interventions are not successful successful reducing nan symptoms of neuropsychiatric syndromes aliases successful cases wherever nan diligent mightiness beryllium a threat to themselves aliases others, pharmacological interventions are preferred. Although nan improvement of pharmacological therapies to dainty neuropsychiatric syndromes has been challenging, respective medications person been approved for usage by nan United States (U.S.) Food and Drug Administration (FDA), specifically for patients pinch neurodegenerative disorders.

In nan coming review, nan researchers discussed successful item 5 of nan awesome neuropsychiatric syndromes, their occurrence, symptoms, and options for pharmacological guidance of these syndromes.

Depression

Depression is 1 of nan communal symptoms of neurodegenerative disorders, pinch a precocious prevalence of awesome depressive disorders among patients pinch dementia. In patients pinch Alzheimer's illness dementia, slump that is not diagnosed aliases treated successful clip often accelerates cognitive decline, termination risk, and mortality risk. The incidence of slump successful different neurodegenerative disorders specified arsenic Parkinson's disease, aggregate strategy atrophy, and dementia pinch Lewy bodies tin often beryllium adjacent to 80%.

Although nan test of slump successful patients pinch neurodegenerative disorders is challenging, selective serotonin reuptake inhibitors and selective serotonergic and noradrenergic reuptake inhibitors person been prescribed. For slump that is life-threatening aliases psychotic, electroconvulsive therapy has often been effective. However, studies person recovered that Alzheimer's illness pathology involving a precocious encephalon amyloid load tin consequence successful guidance to pharmacotherapy.

Disinhibition

Disinhibition has often been observed successful patients pinch progressive supranuclear palsy, Huntington's disease, and Alzheimer's disease. It involves behaviour that is considered inappropriate according to societal norms, specified arsenic rubbing strangers, making sexually definitive jokes aliases remarks, improper intersexual acts, speaking loudly, and oversharing individual details. It is astir communal successful patients pinch nan behavioral version of frontotemporal dementia.

Atypical antipsychotics, selective serotonin reuptake inhibitors, and antiepileptic aliases mood-stabilizing agents person often been utilized to dainty disinhibition. However, nary of these are specifically for treating disinhibition successful patients pinch neurodegenerative disorders.

Apathy

Apathy successful dementia patients is often linked to a two-fold summation successful nan consequence of cognitive decline. It is believed to summation caregiver distress, alteration curen responses, and elevate nan consequence of frailty. While nary approved treatments beryllium for ignorant successful patients pinch neurodegenerative disorders, psychosocial interventions, noninvasive encephalon stimulation, and non-psychostimulant pharmacologic interventions person been explored.

Psychosis

Psychosis, which involves a wide scope of delusions and hallucinations, has varied associations pinch different neurodegenerative disorders. Patients pinch dementia pinch Lewy bodies often acquisition misidentification, misrepresentation, ocular hallucinations, and feelings of presence, while frontotemporal dementia patients often besides acquisition paranoia. The antipsychotics that person been approved for patients pinch neurodegenerative disorders based connected results from placebo-controlled, double-blind tests see Pimavanserin, Risperidone, and Aripiprazole.

Agitation

One of nan astir prevalent and disruptive neuropsychiatric syndromes successful astir neurodegenerative disorders is agitation, which involves kicking, shoving, shouting, hitting, and resisting care. It is associated pinch accelerated progression of dementia and earlier mortality. Agitation besides results successful a higher probability of hospitalization and substantially negatively impacts nan value of life of nan patients and their families.

Agitation is often treated pinch antipsychotics specified arsenic Risperidone, Aripiprazole, Quetiapine, and Brexpiprazole. Antidepressants specified arsenic Citalopram and nan anticonvulsant Carbamazepine person besides been utilized arsenic pharmacological curen options for agitation.

Conclusions

To summarize, nan reappraisal examined nan latest advances successful nan pharmacological guidance of neuropsychiatric syndromes associated pinch neurodegenerative disorders. The researchers provided a broad summary of nan symptoms of 5 awesome neuropsychiatric syndromes and nan pharmacological options for their management.

Journal reference:

  • Cummings, J., Lanctot, K., Grossberg, G., & Ballard, C. (2024). Progress successful Pharmacologic Management of Neuropsychiatric Syndromes successful Neurodegenerative Disorders. JAMA Neurology. DOI: 10.1001/jamaneurol.2024.0586, https://jamanetwork.com/journals/jamaneurology/fullarticle/2816507