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Diagnosis and Management of Neuropsychiatric Symptoms in Alzheimer’s Disease

Abstract

Purpose of Review

To explore the most recent developments in the effective diagnosis and treatment of neuropsychiatric symptoms (NPS) in Alzheimer’s disease (AD).

Recent Findings

The clinical diagnosis of NPS in AD is facilitated by the use of the Neuropsychiatric Inventory (NPI). CT and MRI scans can be useful for detecting structural changes indicating AD. Other promising diagnostic methodologies that are less frequently used in the clinical setting include positron emission tomography (PET) scans for detecting amyloid and blood tests for detecting serum biomarkers. Numerous pharmaceutical agents have been studied for their use in managing NPS, with antipsychotics being popular for managing agitation but also having significant side effects. Non-pharmacological interventions, such as reminiscence therapy and the Describe, Investigate, Create, Evaluate (DICE) approach may be able to provide treatment without such adverse effects.

Summary

Diagnosing AD and the comorbid NPS remains primarily a clinical endeavor with CT and MRI scans sometimes used, but evidence is amassing for the use of other imaging modalities and different lab tests for convenient and empiric diagnosis of AD to distinguish it from other psychiatric illnesses. The number of pharmacologic treatments for NPS that are safe as well as efficacious remains limited, yet non-pharmacologic interventions have clear clinical utility. In addition to searching for more successful pharmacological treatments, further research should focus on novel diagnostic tests and non-pharmacologic therapies.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgments

The editors would like to thank Dr. Madhavi Nagalla for taking the time to review this manuscript.

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Correspondence to Karina Drake.

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David Wolinsky, Karina Drake, and Jolene Bostwick each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

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Wolinsky, D., Drake, K. & Bostwick, J. Diagnosis and Management of Neuropsychiatric Symptoms in Alzheimer’s Disease. Curr Psychiatry Rep 20, 117 (2018). https://doi.org/10.1007/s11920-018-0978-8

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  • DOI: https://doi.org/10.1007/s11920-018-0978-8

Keywords

  • Neuropsychiatric symptoms
  • Alzheimer’s disease
  • Antipsychotics
  • Brain imaging
  • DICE method
  • Acetylcholinesterase inhibitors