Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease

被引:20
作者
Heilman, Kenneth M. [1 ,3 ,4 ,5 ]
Nadeau, Stephen E. [2 ,3 ,4 ,5 ]
机构
[1] Malcom Randall VA Med Ctr, Geriatr Res Educ & Clin Ctr, 1601 SW Archer Rd, Gainesville, FL 32608 USA
[2] Malcom Randall VA Med Ctr, Res Serv, 1601 SW Archer Rd, Gainesville, FL 32608 USA
[3] Malcom Randall VA Med Ctr, Brain Rehabil Res Ctr, 1601 SW Archer Rd, Gainesville, FL 32608 USA
[4] Univ Florida, Coll Med, Malcom Randall VA Med Ctr, Gainesville, FL 32611 USA
[5] Univ Florida, Coll Med, Dept Neurol, Gainesville, FL 32611 USA
关键词
Alzheimer's disease; Emotional facial expression; Emotional prosody; Alexithymia; Agitation; aggression; Depression; Psychosis; Sleep disorders; ATYPICAL ANTIPSYCHOTIC MEDICATIONS; PLACEBO-CONTROLLED TRIAL; DOUBLE-BLIND; PSYCHOLOGICAL SYMPTOMS; BEHAVIORAL DISTURBANCES; OLDER-ADULTS; NONPHARMACOLOGICAL INTERVENTIONS; CHOLINESTERASE-INHIBITORS; COGNITIVE IMPAIRMENT; DIAGNOSTIC-CRITERIA;
D O I
10.1007/s13311-021-01172-w
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Alzheimer's disease is associated with impairments in emotional communication including comprehension and production of facial emotional expressions, comprehension of affective prosody, and alexithymia. It is also associated with disorders of emotional experience including mood disorders (depression and anxiety), agitation/aggression, and psychosis. Agitation/aggression and psychosis are particularly disruptive, are associated with earlier institutionalization, and pose a major challenge to institutional management. Treatment of disorders of emotional experience has been primarily pharmacologic (reviewed here in detail) and has relied heavily on antipsychotic medications despite the small effect sizes demonstrated in a large number of randomized controlled trials and the prevalence of serious side effects associated with these drugs. Recent studies suggest that treatment with pimavanserin, an antipsychotic without activity at dopamine receptors, may represent an important advance for treatment of psychotic manifestations, even as the drug appears to pose significant risk. Dextromethorphan/quinidine may represent an important advance in the treatment of agitation/aggression. There is also compelling evidence that sleep disorders, which are common among patients with Alzheimer's disease and are readily treatable, may potentiate psychotic manifestations and agitation/aggression, but further studies are needed.
引用
收藏
页码:99 / 116
页数:18
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