Lifelong Learning: Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management-View Article

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The article "Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management" by Rajesh R. Tampi, M.D., M.S., and Dilip V. Jeste, M.D., explores the complex neuropsychiatric symptoms (NPS) associated with dementia. NPS affect over 90% of dementia patients and include psychosis, agitation, aggression, depression, anxiety, apathy, and sleep disturbances, leading to increased caregiver burden, high mortality and morbidity, and higher health care costs. The article, published in the American Journal of Psychiatry, reviews evidence on treating NPS with nonpharmacological and pharmacological interventions.<br /><br />The authors emphasize the efficacy and safety of nonpharmacological treatments, which should be the first line of intervention due to their low risk of adverse effects. These include multidisciplinary care, music therapy, outdoor activities, and personalized interventions involving caregivers. In contrast, pharmacological treatments like atypical antipsychotics, including risperidone, olanzapine, and aripiprazole, show limited efficacy and are recommended only for severe or refractory NPS due to their significant risk of adverse events, such as increased mortality and cognitive decline.<br /><br />Emerging treatments like cannabinoids and repetitive transcranial magnetic stimulation (rTMS) show some potential but require more research. The article also discusses person-centered care as a preventive strategy against the development of NPS in dementia and stresses the importance of regular risk-benefit analyses when progressing with any treatment.<br /><br />For future research, the authors advocate expanding investigations into the neurobiology of NPS, embracing novel nonpharmacological treatments, and exploring innovative interventions like ECT and technology-assisted therapies to improve patient outcomes and support caregiving practices.

Keywords

Dementia

Neuropsychiatric symptoms

Nonpharmacological management

Pharmacological management

Caregiver burden

Atypical antipsychotics

Person-centered care

Cannabinoids

Transcranial magnetic stimulation

Neurobiology research