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Psychiatry for Neurologists pp 125–136Cite as

Psychiatric Complications in Dementia

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Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Psychiatric complications are very common in all dementias, which are best conceptualized as neuropsychiatric diseases. The most common complications involve disturbances in emotions (depression, anxiety, apathy, affective lability, irritability, and euphoria), psychosis (delusions and hallucinations), and behavior (restlessness and aggression). These complications are quite heterogeneous and can be difficult to categorize because of fluctuations in symptoms over time and the frequent occurrence of subsyndromal symptoms. Psychiatric co-morbidity is very common in dementia, and most of these symptoms or syndromes are associated with excess functional disability. In addition, psychiatric disturbances in the context of dementia are associated with poorer outcomes, decreased quality of life, increased institutionalization, and caregiver distress. Our understanding of the etiology and pathophysiology of behavioral and psychological signs and symptoms in dementia is limited. Screening instruments are available to assist in clinical evaluation and there are a variety of treatment options, both psychopharmacological and psychosocial. This chapter covers the neurobehavioral complications of common dementias not covered elsewhere in this book, specifically Alzheimer’s disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD).

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References

  1. Alexopoulos GS, Meyers BS, Young RC, Mattis S, Kakuma T. The course of geriatric depression with “reversible dementia”: a controlled study. Am J Psychiatry 1993;150:1693–1699.

    PubMed  CAS  Google Scholar 

  2. Steffens DC, Taylor WD, Krishnan KR. Progression of subcortical ischemic disease from vascular depression to vascular dementia. Am J Psychiatry 2003;160:1751–1756.

    Article  PubMed  Google Scholar 

  3. Cummings JL. The Neuropsychiatry of Alzheimer’s Disease and Related Dementias. London: Martin Duntz Ltd, Taylor and Francis Group; 2003.

    Google Scholar 

  4. Lee HB, Lyketsos CG. Depression in Alzheimer’s disease: heterogeneity and related issues. Biol Psychiatry 2003;54:353–362.

    Article  PubMed  CAS  Google Scholar 

  5. Olin JT, Katz IR, Meyers BS, Schneider LS, Lebowitz BD. Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background. Am J Geriatr Psychiatry 2002;10:264.

    Google Scholar 

  6. Olin JT, Schneider LS, Katz IR, et al. Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry 2002;10:125–128.

    Article  PubMed  Google Scholar 

  7. Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord 2000;59:97–106.

    Article  PubMed  CAS  Google Scholar 

  8. Groves WC, Brandt J, Steinberg M, et al. Vascular dementia and Alzheimer’s disease: is there a difference? A comparison of symptoms by disease duration. J Neuropsychiatry Clin Neurosci 2000;12:305–315.

    PubMed  CAS  Google Scholar 

  9. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry 2000;157:708–714.

    Article  PubMed  CAS  Google Scholar 

  10. Mendez MF, Perryman KM. Neuropsychiatric features of frontotemporal dementia: evaluation of consensus criteria and review. J Neuropsychiatry Clin Neurosci 2002;14:424–429.

    PubMed  Google Scholar 

  11. Levy ML, Miller BL, Cummings JL, Fairbanks LA, Craig A. Alzheimer disease and frontotemporal dementias: behavioral distinctions. Arch Neurol 1996;53:687–690.

    PubMed  CAS  Google Scholar 

  12. Lyketsos CG, Sheppard JM, Steinberg M, et al. Neuropsychiatric disturbance in Alzheimer disease clusters into three groups: the Cache County study. Int J Geriatr Psychiatry 2001;16:1043–1053.

    Article  PubMed  CAS  Google Scholar 

  13. Frisoni GB, Rozzini L, Binetti G, et al. Behavioral syndromes in Alzheimer’s disease: description and correlates. Dement Geriatr Cogn Disord 1999;10:130–138.

    Article  PubMed  CAS  Google Scholar 

  14. Jeste DV, Finkel SI. Psychosis of Alzheimer’s disease and related dementias: diagnostic criteria for a distinct syndrome. Am J Geriatr Psychiatry 2000;8:29–34.

    Article  PubMed  CAS  Google Scholar 

  15. Devanand DP, Jacobs DM, Tang MX, et al. The course of psychopathological features in mild to moderate Alzheimer disease. Arch Gen Psychiatry 1997;54:257–263.

    PubMed  CAS  Google Scholar 

  16. Hope T, Keene J, Fairburn CG, Jacoby R, McShane R. Natural history of behavioral changes and psychiatric symptoms in Alzheimer’s disease: a longitudinal study. Br J Psychiatry 1999;174:39–44.

    PubMed  CAS  Google Scholar 

  17. Snowden JS, Neary D, Mann DM. Frontotemporal dementia. Br J Psychiatry 2002;180:140–143.

    Article  PubMed  Google Scholar 

  18. American Geriatrics Society and American Association for Geriatric Psychiatry. Consensus statement on improving the quality of mental health care in U.S. nursing homes: management of depression and behavioral symptoms associated with dementia. J Am Geriatr Soc 2003;51:1287–1298.

    Article  Google Scholar 

  19. Alexopolous GS, Katz IR, Reynolds CF III, et al. The expert consensus guideline series: pharmacotherapy of depressive disorders in older patients. Postgraduate Medicine Special Report 2001;1–86.

    Google Scholar 

  20. Lyketsos CG, DelCampo L, Steinberg M, et al. Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry 2003;60:737–746.

    Article  PubMed  CAS  Google Scholar 

  21. Swartz JR, Miller BL, Lesser IM, Darby AL. Frontotemporal dementia: treatment response to serotonin selective reuptake inhibitors. J Clin Psychiatry 1997;58:212–216.

    PubMed  CAS  Google Scholar 

  22. American Psychiatric Association Work Group on Alzheimer’s Disease and Related Dementias. Practice guidelines for the treatment of patients with Alzheimer’s disease and other dementias of late life. Am J Psychiatry 1997;154:1–39.

    Google Scholar 

  23. Alexopolous GS, Silver JM, Kahn DA, et al. Treatment of agitation in older persons with dementia. Postgrad Med 1998; 1–88.

    Google Scholar 

  24. Jeste DV, Caligiuri MP, Paulsen JS, et al. Risk of tardive dyskinesia in older patients: a prospective longitudinal study of 266 outpatients. Arch Gen Psychiatry 1995;52:756–765.

    PubMed  CAS  Google Scholar 

  25. Katz IR, Jeste DV, Mintzer JE, Clyde C, Napolitano J, Brecher M. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. J Clin Psychiatry 1999;60:107–115.

    Article  PubMed  CAS  Google Scholar 

  26. Brodaty H, Ames D, Snowdon JS, et al. A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry 2003;64:134–143.

    Article  PubMed  CAS  Google Scholar 

  27. Street JS, Clark WS, Gannon KS, et al. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 2000;57:968–976.

    Article  PubMed  CAS  Google Scholar 

  28. Jeste DV, Okamoto A, Napolitano J, Kane JM, Martinez RA. Low incidence of persistent tardive dyskinesia in elderly patients with dementia treated with risperidone. Am J Psychiatry 2000;157:1150–1155.

    Article  PubMed  CAS  Google Scholar 

  29. Pollock BG, Mulsant BH, Rosen J, et al. Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry 2002;159:460–465.

    Article  PubMed  Google Scholar 

  30. Tariot PN, Erb R, Podgorski CA, et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998;155:54–61.

    PubMed  CAS  Google Scholar 

  31. Porsteinsson AP, Tariot PN, Erb R, et al. Placebo-controlled study of divalproex sodium for agitation in dementia. Am J Geriatr Psychiatry 2001;9:58–66.

    Article  PubMed  CAS  Google Scholar 

  32. McKeith I, Del Ser T, Spano PF, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, doubleblind, placebo-controlled international study. Lancet 2000;356:2031–2036.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Departments of Psychiatry and Neurology, Philadelphia, VA

    Daniel Weintraub MD

  2. Medical Center, University of Pennsylvania School of Medicine, Philadelphia, PA

    Daniel Weintraub MD

  3. Department of Psychiatry, Strong Memorial Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY

    Anton P. Porsteinsson MD

Authors
  1. Daniel Weintraub MD
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  2. Anton P. Porsteinsson MD
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Editor information

Editors and Affiliations

  1. Department of Psychiatry and Neurosciences, University of California, San Diego

    Dilip V. Jests MD

  2. Department of Psychiatry and Neurosciences, VA San Diego Healthcare System, San Diego, CA

    Dilip V. Jests MD

  3. Parkinson’s Disease and Movement Disorders Center, NeuroHealth, Warwick, RI

    Joseph H. Friedman MD

  4. University Medical School, Providence, RI

    Joseph H. Friedman MD

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© 2006 Humana Press Inc., Totowa, NJ

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Weintraub, D., Porsteinsson, A.P. (2006). Psychiatric Complications in Dementia. In: Jests, D.V., Friedman, J.H. (eds) Psychiatry for Neurologists. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59259-960-8_11

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  • DOI: https://doi.org/10.1007/978-1-59259-960-8_11

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-483-8

  • Online ISBN: 978-1-59259-960-8

  • eBook Packages: MedicineMedicine (R0)

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