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Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel
Author(s) -
Kales Helen C.,
Gitlin Laura N.,
Lyketsos Constantine G.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12730
Subject(s) - medicine , dementia , apathy , context (archaeology) , psychiatry , depression (economics) , anxiety , multidisciplinary approach , adverse effect , intensive care medicine , disease , cognition , pathology , paleontology , macroeconomics , economics , biology , social science , sociology
Noncognitive neuropsychiatric symptoms ( NPS ) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the F ood and D rug A dministration has not approved pharmacotherapy for NPS , psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real‐world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the U niversity of M ichigan P rogram for P ositive A ging, working in collaboration with the J ohns H opkins A lzheimer's D isease R esearch C enter and C enter for I nnovative C are in A ging sponsored and convened a multidisciplinary expert panel in D etroit, M ichigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real‐world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.