Abstract

SOME PHARMACOLOGICAL TREATMENT OPTIONS OF NEUROPSYCHIATRIC SYMPTOMS IN PATIENTS WITH NEUROCOGNITIVE DISORDERS

M. Arnaoudova, A. Tsvetkova and V. Petkova*

ABSTRACT

Introduction: Psychological and behavioral disturbances (BPSD) are an integral part of dementia process and present severe problems to both dementia patients and their caregivers. This might lead to excessive use of psychotropic drugs with risk/benefit issues. Aim: To investigate whether psychotropic drugs are acceptable treatment for some BPSD in dementia. We also searched for somatic comorbidity and medications received. Method: We examined 216 in-patients (mean age 73.18) with Alzheimer’s dementia (AD) and Vascular dementia (VaD), who were under psychotropic treatment. The patients underwent clinical psychiatric assessment, physical examination and evaluation on MMSE, NPI, Cohen-Mansfield Inventory. Descriptive statistics and t-test for comparing the means were applied. Analyses were done using Excel 2007. Summary of results: Users of conventional antipsychotics were 36.36% VaD patients and 34.28% AD patients; of atypical antipsychotics 60% of AD and 53% of VaD patients. The prevailing aggressive behavioural disturbances in VaD were consistent in preference of mood stabilizers (15.32%) and benzodiazepines (55.86%), than in AD (respectively 6.67% and 37.14%) p<0,05. Statistically significant difference between prescriptions of Donepezil (26.67%) in AD and 5.41% in VaD (p=7,35.10-7<0,05) and in use of Memantine (31.43%) in AD, respectively 5.41% in VaD (p=7,53.10-7<0,05) was found. Patients with VaD had a significantly higher number of chronic conditions (mean=1.88) than those with AD (mean = 0.96) р=1,2.10-10<0,05. The average number of medications applied for somatic comorbidity in VaD was significantly higher (mean=2.51) than in AD patients (mean=1.61) р=4,9.10-8<0,05. The risk of complications with antipsychotics is mainly dose related or could be due to a faster titration. The role of cognitive enhancers in combined treatment or as an alternative in some target groups should be considered. Conclusion: A comprehensive medical work-up and close monitoring are prerequisites for a favourable treatment and outcome.

Keywords: pharmacological treatment, psychiatric comorbidity, elderly patients, Neurocognitive disorders.