Helen C Kales1, Constantine G Lyketsos2, Erin M Miller1, Clive Ballard3. 1. Program for Positive Aging,Department of Psychiatry,University of Michigan,Ann Arbor,Michigan,USA. 2. Department of Psychiatry and Behavioral Sciences,Johns Hopkins Bayview and Johns Hopkins University,Baltimore,Maryland,USA. 3. University of Exeter Medical School,Exeter,UK.
Abstract
ABSTRACT Objectives: Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, a condition occurring in more than 40 million people worldwide. BPSD present a considerable treatment challenge for prescribers and healthcare professionals. Our purpose was to prioritize existing and emerging treatments for BPSD in Alzheimer's disease (AD) overall, as well as specifically for agitation and psychosis. DESIGN: International Delphi consensus process. Two rounds of feedback were conducted, followed by an in-person meeting to ratify the outcome of the electronic process. SETTINGS: 2015 International Psychogeriatric Association meeting. PARTICIPANTS: Expert panel comprised of 11 international members with clinical and research expertise in BPSD management. RESULTS: Consensus outcomes showed a clear preference for an escalating approach to the management of BPSD in AD commencing with the identification of underlying causes. For BPSD overall and for agitation, caregiver training, environmental adaptations, person-centered care, and tailored activities were identified as first-line approaches prior to any pharmacologic approaches. If pharmacologic strategies were needed, citalopram and analgesia were prioritized ahead of antipsychotics. In contrast, for psychosis, pharmacologic options, and in particular, risperidone, were prioritized following the assessment of underlying causes. Two tailored non-drug approaches (DICE and music therapy) were agreed upon as the most promising non-pharmacologic treatment approaches for BPSD overall and agitation, with dextromethorphan/quinidine as a promising potential pharmacologic candidate for agitation. Regarding future treatments for psychosis, the greatest priority was placed on pimavanserin. CONCLUSIONS: This international consensus panel provided clear suggestions for potential refinement of current treatment criteria and prioritization of emerging therapies.
ABSTRACT Objectives: Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, a condition occurring in more than 40 million people worldwide. BPSD present a considerable treatment challenge for prescribers and healthcare professionals. Our purpose was to prioritize existing and emerging treatments for BPSD in Alzheimer's disease (AD) overall, as well as specifically for agitation and psychosis. DESIGN: International Delphi consensus process. Two rounds of feedback were conducted, followed by an in-person meeting to ratify the outcome of the electronic process. SETTINGS: 2015 International Psychogeriatric Association meeting. PARTICIPANTS: Expert panel comprised of 11 international members with clinical and research expertise in BPSD management. RESULTS: Consensus outcomes showed a clear preference for an escalating approach to the management of BPSD in AD commencing with the identification of underlying causes. For BPSD overall and for agitation, caregiver training, environmental adaptations, person-centered care, and tailored activities were identified as first-line approaches prior to any pharmacologic approaches. If pharmacologic strategies were needed, citalopram and analgesia were prioritized ahead of antipsychotics. In contrast, for psychosis, pharmacologic options, and in particular, risperidone, were prioritized following the assessment of underlying causes. Two tailored non-drug approaches (DICE and music therapy) were agreed upon as the most promising non-pharmacologic treatment approaches for BPSD overall and agitation, with dextromethorphan/quinidine as a promising potential pharmacologic candidate for agitation. Regarding future treatments for psychosis, the greatest priority was placed on pimavanserin. CONCLUSIONS: This international consensus panel provided clear suggestions for potential refinement of current treatment criteria and prioritization of emerging therapies.
Authors: Monika Marcinkowska; Adam Bucki; Joanna Sniecikowska; Agnieszka Zagórska; Nikola Fajkis-Zajączkowska; Agata Siwek; Monika Gluch-Lutwin; Paweł Żmudzki; Magdalena Jastrzebska-Wiesek; Anna Partyka; Anna Wesołowska; Michał Abram; Katarzyna Przejczowska-Pomierny; Agnieszka Cios; Elżbieta Wyska; Kamil Mika; Magdalena Kotańska; Paweł Mierzejewski; Marcin Kolaczkowski Journal: J Med Chem Date: 2021-08-26 Impact factor: 7.446
Authors: Gill Livingston; Jonathan Huntley; Andrew Sommerlad; David Ames; Clive Ballard; Sube Banerjee; Carol Brayne; Alistair Burns; Jiska Cohen-Mansfield; Claudia Cooper; Sergi G Costafreda; Amit Dias; Nick Fox; Laura N Gitlin; Robert Howard; Helen C Kales; Mika Kivimäki; Eric B Larson; Adesola Ogunniyi; Vasiliki Orgeta; Karen Ritchie; Kenneth Rockwood; Elizabeth L Sampson; Quincy Samus; Lon S Schneider; Geir Selbæk; Linda Teri; Naaheed Mukadam Journal: Lancet Date: 2020-07-30 Impact factor: 79.321