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Dr. Daniel Press. Manejo de los síntomas neuropsiquiátricos de la demencia. 07 DE ABRIL DE 2020. UpToDate. Disponible en: https://www.uptodate.com/contents/management-of-neuropsychiatric-symptoms-of-dementia?search=demencia%20ancianos&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H1560970366

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Management of neuropsychiatric symptoms of dementia

INTRODUCTION

Neuropsychiatric symptoms in Alzheimer disease (AD) and other types of dementia are extremely common and often much more troubling than cognitive symptoms [ 1]. This topic will review the causes and treatment of behavioral disturbance and other neuropsychiatric symptoms related to dementia. These symptoms include agitation, aggression, delusions, hallucinations, paranoia, wandering, depression, apathy, disinhibition, and sleep disturbances ( table 1). One or more of these symptoms are observed in 60 to 90 percent of patients with dementia; the prevalence increases with disease severity [ 2-6]. The presence of neuropsychiatric symptoms leads to greater functional impairment in patients with dementia and cognitive impairment [ 6,7]. These behaviors often accelerate or lead to nursing home placement [ 7-11].

Treatment of the cognitive features of dementia, the approach to safety and societal issues related to dementia, and the palliative care of patients with advanced dementia are discussed separately. (See "Treatment of Alzheimer disease" and "Frontotemporal dementia: Treatment" and "Prognosis and treatment of dementia with Lewy bodies" and "Treatment of vascular cognitive impairment and dementia" and "Management of the patient with dementia" and "Care of patients with advanced dementia".)

SYMPTOM ASSESSMENT

Neuropsychiatric symptoms are common in dementia, but may be under-reported by patients and families [ 12,13]. Screening for agitation and other neuropsychiatric symptoms in patients with dementia should be done at regular follow-up visits [ 13]. We ask both caregivers and patients explicit questions regarding such symptoms, for example, "Does the patient have any behaviors that worry you?" and "Do you/the patient have hallucinations, see things, or hear voices that aren't there?" and "How do you/the patient sleep at night?" Clinicians should regularly inquire about aggression, delusions, hallucinations, paranoia, wandering, depression, apathy, and disinhibition. The presence of either delusions or hallucinations is associated with increased risk for cognitive and functional decline; hallucinations predict institutionalization and death [ 10].

Behavioral disturbances commonly peak in the late afternoon or evening, a phenomenon often referred to as "sundowning." Sundowning affects up to two-thirds of patients with dementia and is closely related to disturbed circadian rhythms [ 11,14-17]. Risk factors include poor light exposure and disturbed sleep [ 18]. Sleep disorders are common in dementia but may also be a manifestation of or contributor to neuropsychiatric symptoms. A sleep history should be regularly assessed. (See "Sleep-wake disturbances and sleep disorders in patients with dementia", section on 'Clinical assessment'.)

Delusions are common in patients with Alzheimer disease (AD), with a reported prevalence of 30 percent in patients with severe AD [ 2]. A long-term follow-up study suggests that these may be more pervasive; among 456 patients with mild to moderate AD followed for a mean of 4.5 years, 34 percent had delusions at baseline, but 70 percent had them during at least one evaluation [ 10]. Paranoid delusions in particular can be very distressing to the patient or caregivers. Common paranoid delusions include beliefs that the house has been invaded, that personal objects have been misplaced or stolen, that family members have been replaced by impostors (Capgras syndrome), or that spouses have been unfaithful. By contrast, some delusions or hallucinations may be fleeting or unobtrusive, which impacts how aggressively that are treated.

Literature review current through: May 2022. | This topic last updated: Apr 07, 2022.

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REFERENCES

1. Cummings J, Ritter A, Rothenberg K. Advances in Management of Neuropsychiatric Syndromes in Neurodegenerative Diseases. Curr Psychiatry Rep 2019; 21:79.

2. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46:130.

3. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry 2000; 157:708.

4. Lyketsos CG, Lopez O, Jones B, et al. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. JAMA 2002; 288:1475.

5. Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc 2004; 52:1277.

6. Peters KR, Rockwood K, Black SE, et al. Characterizing neuropsychiatric symptoms in subjects referred to dementia clinics. Neurology 2006; 66:523.

7. Scarmeas N, Brandt J, Blacker D, et al. Disruptive behavior as a predictor in Alzheimer disease. Arch Neurol 2007; 64:1755.

8. O'Donnell BF, Drachman DA, Barnes HJ, et al. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol 1992; 5:45.

9. Morriss RK, Rovner BW, Folstein MF, German PS. Delusions in newly admitted residents of nursing homes. Am J Psychiatry 1990; 147:299.

10. Scarmeas N, Brandt J, Albert M, et al. Delusions and hallucinations are associated with worse outcome in Alzheimer disease. Arch Neurol 2005; 62:1601.

11. Gallagher-Thompson D, Brooks JO 3rd, Bliwise D, et al. The relations among caregiver stress, "sundowning" symptoms, and cognitive decline in Alzheimer's disease. J Am Geriatr Soc 1992; 40:807.

12. Savva GM, Zaccai J, Matthews FE, et al. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br J Psychiatry 2009; 194:212.

13. Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012; 308:2020.

14. Ancoli-Israel S, Gehrman P, Martin JL, et al. Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients. Behav Sleep Med 2003; 1:22.

15. Evans LK. Sundown syndrome in institutionalized elderly. J Am Geriatr Soc 1987; 35:101.

16. Vitiello MV, Bliwise DL, Prinz PN. Sleep in Alzheimer's disease and the sundown syndrome. Neurology 1992; 42:83.

17. Volicer L, Harper DG, Manning BC, et al. Sundowning and circadian rhythms in Alzheimer's disease. Am J Psychiatry 2001; 158:704.

18. Martin J, Marler M, Shochat T, Ancoli-Israel S. Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease. Chronobiol Int 2000; 17:405.

19. Chibnall JT, Tait RC. Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain 2001; 92:173.

20. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002; 50:S205.

21. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003; 4:9.

22. Sky AJ, Grossberg GT. The use of psychotropic medication in the management of problem behaviors in the patient with Alzheimer's disease. Med Clin North Am 1994; 78:811.

23. Gitlin LN, Winter L, Dennis MP, et al. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc 2010; 58:1465.

24. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013; 173:293.

25. Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA 2006; 295:2148.

26. Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med 2006; 145:713.

27. Pieper MJ, Francke AL, van der Steen JT, et al. Effects of a Stepwise Multidisciplinary Intervention for Challenging Behavior in Advanced Dementia: A Cluster Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:261.

28. Gurwitz JH, Bonner A, Berwick DM. Reducing Excessive Use of Antipsychotic Agents in Nursing Homes. JAMA 2017; 318:118.

29. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet 2017; 390:2673.

30. Ayalon L, Gum AM, Feliciano L, Areán PA. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Arch Intern Med 2006; 166:2182.

31. Gitlin LN, Winter L, Dennis MP, et al. A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA 2010; 304:983.

32. Moniz Cook ED, Swift K, James I, et al. Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database Syst Rev 2012; :CD006929.

33. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry 2014; 205:436.

34. Sloane PD, Hoeffer B, Mitchell CM, et al. Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. J Am Geriatr Soc 2004; 52:1795.

35. Forrester LT, Maayan N, Orrell M, et al. Aromatherapy for dementia. Cochrane Database Syst Rev 2014; :CD003150.

36. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA 2003; 290:2015.

37. Clark ME, Lipe AW, Bilbrey M. Use of music to decrease aggressive behaviors in people with dementia. J Gerontol Nurs 1998; 24:10.

38. Gerdner LA. Effects of individualized versus classical "relaxation" music on the frequency of agitation in elderly persons with Alzheimer's disease and related disorders. Int Psychogeriatr 2000; 12:49.

39. Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. Am J Geriatr Psychiatry 2001; 9:361.

40. van der Steen JT, van Soest-Poortvliet MC, van der Wouden JC, et al. Music-based therapeutic interventions for people with dementia. Cochrane Database Syst Rev 2017; 5:CD003477.

41. Viggo Hansen N, Jørgensen T, Ørtenblad L. Massage and touch for dementia. Cochrane Database Syst Rev 2006; :CD004989.

42. Scherder E, Herr K, Pickering G, et al. Pain in dementia. Pain 2009; 145:276.

43. Husebo BS, Ballard C, Sandvik R, et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 2011; 343:d4065.

44. Sandvik RK, Selbaek G, Seifert R, et al. Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: a cluster randomized trial. Eur J Pain 2014; 18:1490.

45. The management of chronic pain in older persons: AGS Panel on Chronic Pain in Older Persons. American Geriatrics Society. J Am Geriatr Soc 1998; 46:635.

46. Wang J, Yu JT, Wang HF, et al. Pharmacological treatment of neuropsychiatric symptoms in Alzheimer's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2015; 86:101.

47. Trinh NH, Hoblyn J, Mohanty S, Yaffe K. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis. JAMA 2003; 289:210.

48. Cummings JL, Schneider E, Tariot PN, et al. Behavioral effects of memantine in Alzheimer disease patients receiving donepezil treatment. Neurology 2006; 67:57.

49. Wilcock GK, Ballard CG, Cooper JA, Loft H. Memantine for agitation/aggression and psychosis in moderately severe to severe Alzheimer's disease: a pooled analysis of 3 studies. J Clin Psychiatry 2008; 69:341.

50. Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293:596.

51. McShane R, Areosa Sastre A, Minakaran N. Memantine for dementia. Cochrane Database Syst Rev 2006; :CD003154.

52. FDA Drug Safety Communication: Revised recommendations for Celexa (citalopram hydrobromide) related to a potential risk of abnormal heart rhythms with high doses http://www.fda.gov/Drugs/DrugSafety/ucm297391.htm (Accessed on March 28, 2012).

53. Bergh S, Selbæk G, Engedal K. Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. BMJ 2012; 344:e1566.

54. Seitz DP, Adunuri N, Gill SS, et al. Antidepressants for agitation and psychosis in dementia. Cochrane Database Syst Rev 2011; :CD008191.

55. Pollock BG, Mulsant BH, Rosen J, et al. Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry 2002; 159:460.

56. Finkel SI, Mintzer JE, Dysken M, et al. A randomized, placebo-controlled study of the efficacy and safety of sertraline in the treatment of the behavioral manifestations of Alzheimer's disease in outpatients treated with donepezil. Int J Geriatr Psychiatry 2004; 19:9.

57. Nyth AL, Gottfries CG. The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders. A Nordic multicentre study. Br J Psychiatry 1990; 157:894.

58. Auchus AP, Bissey-Black C. Pilot study of haloperidol, fluoxetine, and placebo for agitation in Alzheimer's disease. J Neuropsychiatry Clin Neurosci 1997; 9:591.

59. Olafsson K, Jørgensen S, Jensen HV, et al. Fluvoxamine in the treatment of demented elderly patients: a double-blind, placebo-controlled study. Acta Psychiatr Scand 1992; 85:453.

60. Porsteinsson AP, Drye LT, Pollock BG, et al. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 2014; 311:682.

61. Pollock BG, Mulsant BH, Rosen J, et al. A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatr Psychiatry 2007; 15:942.

62. Gaber S, Ronzoli S, Bruno A, Biagi A. Sertraline versus small doses of haloperidol in the treatment of agitated behavior in patients with dementia. Arch Gerontol Geriatr Suppl 2001; 7:159.

63. Teri L, Logsdon RG, Peskind E, et al. Treatment of agitation in AD: a randomized, placebo-controlled clinical trial. Neurology 2000; 55:1271.

64. Sultzer DL, Gray KF, Gunay I, et al. A double-blind comparison of trazodone and haloperidol for treatment of agitation in patients with dementia. Am J Geriatr Psychiatry 1997; 5:60.

65. Tariot PN, Erb R, Podgorski CA, et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry 1998; 155:54.

66. Olin JT, Fox LS, Pawluczyk S, et al. A pilot randomized trial of carbamazepine for behavioral symptoms in treatment-resistant outpatients with Alzheimer disease. Am J Geriatr Psychiatry 2001; 9:400.

67. Lindenmayer JP, Kotsaftis A. Use of sodium valproate in violent and aggressive behaviors: a critical review. J Clin Psychiatry 2000; 61:123.

68. Porsteinsson AP, Tariot PN, Erb R, et al. Placebo-controlled study of divalproex sodium for agitation in dementia. Am J Geriatr Psychiatry 2001; 9:58.

69. Herrmann N, Lanctôt K, Myszak M. Effectiveness of gabapentin for the treatment of behavioral disorders in dementia. J Clin Psychopharmacol 2000; 20:90.

70. Riemersma-van der Lek RF, Swaab DF, Twisk J, et al. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA 2008; 299:2642.

71. Jansen SL, Forbes DA, Duncan V, Morgan DG. Melatonin for cognitive impairment. Cochrane Database Syst Rev 2006; :CD003802.

72. Gehrman PR, Connor DJ, Martin JL, et al. Melatonin fails to improve sleep or agitation in double-blind randomized placebo-controlled trial of institutionalized patients with Alzheimer disease. Am J Geriatr Psychiatry 2009; 17:166.

73. Dowling GA, Burr RL, Van Someren EJ, et al. Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. J Am Geriatr Soc 2008; 56:239.

74. Singer C, Tractenberg RE, Kaye J, et al. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease. Sleep 2003; 26:893.

75. McCleery J, Cohen DA, Sharpley AL. Pharmacotherapies for sleep disturbances in Alzheimer's disease. Cochrane Database Syst Rev 2014; :CD009178.

76. de Jonghe A, Korevaar JC, van Munster BC, de Rooij SE. Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia. Are there implications for delirium? A systematic review. Int J Geriatr Psychiatry 2010; 25:1201.

77. Meehan KM, Wang H, David SR, et al. Comparison of rapidly acting intramuscular olanzapine, lorazepam, and placebo: a double-blind, randomized study in acutely agitated patients with dementia. Neuropsychopharmacology 2002; 26:494.

78. Borson S, Raskind MA. Clinical features and pharmacologic treatment of behavioral symptoms of Alzheimer's disease. Neurology 1997; 48:S17.

79. Corbett A, Burns A, Ballard C. Don't use antipsychotics routinely to treat agitation and aggression in people with dementia. BMJ 2014; 349:g6420.

80. Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia. Am J Psychiatry 2016; 173:543.

81. Antipsychotic drugs for dementia: a balancing act. Lancet Neurol 2009; 8:125.

82. Declercq T, Petrovic M, Azermai M, et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev 2013; :CD007726.

83. Devanand DP, Mintzer J, Schultz SK, et al. Relapse risk after discontinuation of risperidone in Alzheimer's disease. N Engl J Med 2012; 367:1497.

84. Tariot PN, Cummings JL, Soto-Martin ME, et al. Trial of Pimavanserin in Dementia-Related Psychosis. N Engl J Med 2021; 385:309.

85. Ballard C, Orrell M, YongZhong S, et al. Impact of Antipsychotic Review and Nonpharmacological Intervention on Antipsychotic Use, Neuropsychiatric Symptoms, and Mortality in People With Dementia Living in Nursing Homes: A Factorial Cluster-Randomized Controlled Trial by the Well-Being and Health for People With Dementia (WHELD) Program. Am J Psychiatry 2016; 173:252.

86. Patel AN, Lee S, Andrews HF, et al. Prediction of Relapse After Discontinuation of Antipsychotic Treatment in Alzheimer's Disease: The Role of Hallucinations. Am J Psychiatry 2017; 174:362.

87. Lonergan E, Luxenberg J, Colford J. Haloperidol for agitation in dementia. Cochrane Database Syst Rev 2002; :CD002852.

88. Lee PE, Gill SS, Freedman M, et al. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ 2004; 329:75.

89. Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 2006; 14:191.

90. Ballard C, Banister C, Khan Z, et al. Evaluation of the safety, tolerability, and efficacy of pimavanserin versus placebo in patients with Alzheimer's disease psychosis: a phase 2, randomised, placebo-controlled, double-blind study. Lancet Neurol 2018; 17:213.

91. Ballard C, Margallo-Lana M, Juszczak E, et al. Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. BMJ 2005; 330:874.

92. Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med 2006; 355:1525.

93. Devanand DP, Sackeim HA, Brown RP, Mayeux R. A pilot study of haloperidol treatment of psychosis and behavioral disturbance in Alzheimer's disease. Arch Neurol 1989; 46:854.

94. Dev VJ, Rosenberg T, Krupp P. Agranulocytosis and clozapine. BMJ 1994; 309:54.

95. Atypical antipsychotics in the elderly. Med Lett Drugs Ther 2005; 47:61.

96. Kuehn BM. FDA warns antipsychotic drugs may be risky for elderly. JAMA 2005; 293:2462.

97. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294:1934.

98. Ballard C, Hanney ML, Theodoulou M, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009; 8:151.

99. Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005; 353:2335.

100. Schneeweiss S, Setoguchi S, Brookhart A, et al. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ 2007; 176:627.

101. Huybrechts KF, Gerhard T, Crystal S, et al. Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study. BMJ 2012; 344:e977.

102. Gerhard T, Huybrechts K, Olfson M, et al. Comparative mortality risks of antipsychotic medications in community-dwelling older adults. Br J Psychiatry 2014; 205:44.

103. Kales HC, Kim HM, Zivin K, et al. Risk of mortality among individual antipsychotics in patients with dementia. Am J Psychiatry 2012; 169:71.

104. Rossom RC, Rector TS, Lederle FA, Dysken MW. Are all commonly prescribed antipsychotics associated with greater mortality in elderly male veterans with dementia? J Am Geriatr Soc 2010; 58:1027.

105. Maust DT, Kim HM, Seyfried LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry 2015; 72:438.

106. Weintraub D, Chiang C, Kim HM, et al. Association of Antipsychotic Use With Mortality Risk in Patients With Parkinson Disease. JAMA Neurol 2016; 73:535.

107. Rochon PA, Normand SL, Gomes T, et al. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med 2008; 168:1090.

108. Howard R, Costafreda SG, Karcher K, et al. Baseline characteristics and treatment-emergent risk factors associated with cerebrovascular event and death with risperidone in dementia patients. Br J Psychiatry 2016; 209:378.

109. Brodaty H, Ames D, Snowdon J, et al. A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry 2003; 64:134.

110. Wooltorton E. Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. CMAJ 2002; 167:1269.

111. Wooltorton E. Olanzapine (Zyprexa): increased incidence of cerebrovascular events in dementia trials. CMAJ 2004; 170:1395.

112. Herrmann N, Mamdani M, Lanctôt KL. Atypical antipsychotics and risk of cerebrovascular accidents. Am J Psychiatry 2004; 161:1113.

113. Gill SS, Rochon PA, Herrmann N, et al. Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. BMJ 2005; 330:445.

114. Barnett MJ, Wehring H, Perry PJ. Comparison of risk of cerebrovascular events in an elderly VA population with dementia between antipsychotic and nonantipsychotic users. J Clin Psychopharmacol 2007; 27:595.

115. Pioro EP, Brooks BR, Cummings J, et al. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect. Ann Neurol 2010; 68:693.

116. Brooks BR, Thisted RA, Appel SH, et al. Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology 2004; 63:1364.

117. Cummings JL, Lyketsos CG, Peskind ER, et al. Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia: A Randomized Clinical Trial. JAMA 2015; 314:1242.

118. Ballard C, Sharp S, Corbett A. Dextromethorphan and Quinidine for Treating Agitation in Patients With Alzheimer Disease Dementia. JAMA 2015; 314:1233.

119. American Psychiatric Association Practice Guideline: Treatment of patients with Alzheimer's disease and other dementias, Second edition. http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1679489.

120. Kröpelin TF, Neyens JC, Halfens RJ, et al. Fall determinants in older long-term care residents with dementia: a systematic review. Int Psychogeriatr 2013; 25:549.

121. Pellfolk TJ, Gustafson Y, Bucht G, Karlsson S. Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial. J Am Geriatr Soc 2010; 58:62.

122. Evans LK, Strumpf NE, Allen-Taylor SL, et al. A clinical trial to reduce restraints in nursing homes. J Am Geriatr Soc 1997; 45:675.

123. Testad I, Aasland AM, Aarsland D. The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial. Int J Geriatr Psychiatry 2005; 20:587.

124. Kuske B, Luck T, Hanns S, et al. Training in dementia care: a cluster-randomized controlled trial of a training program for nursing home staff in Germany. Int Psychogeriatr 2009; 21:295.

125. Jones BN, Reifler BV. Depression coexisting with dementia. Evaluation and treatment. Med Clin North Am 1994; 78:823.

126. Dal Forno G, Palermo MT, Donohue JE, et al. Depressive symptoms, sex, and risk for Alzheimer's disease. Ann Neurol 2005; 57:381.

127. Olin JT, Schneider LS, Katz IR, et al. Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry 2002; 10:125.

128. Bains J, Birks J, Dening T. Antidepressants for treating depression in dementia. Cochrane Database Syst Rev 2002; :CD003944.

129. Lyketsos CG, Lee HB. Diagnosis and treatment of depression in Alzheimer's disease. A practical update for the clinician. Dement Geriatr Cogn Disord 2004; 17:55.

130. Kiosses DN, Ravdin LD, Gross JJ, et al. Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry 2015; 72:22.

131. Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2014; :CD009125.

132. Gottfries CG, Karlsson I, Nyth AL. Treatment of depression in elderly patients with and without dementia disorders. Int Clin Psychopharmacol 1992; 6 Suppl 5:55.

133. Rosenberg PB, Drye LT, Martin BK, et al. Sertraline for the treatment of depression in Alzheimer disease. Am J Geriatr Psychiatry 2010; 18:136.

134. Weintraub D, Rosenberg PB, Drye LT, et al. Sertraline for the treatment of depression in Alzheimer disease: week-24 outcomes. Am J Geriatr Psychiatry 2010; 18:332.

135. Banerjee S, Hellier J, Dewey M, et al. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011; 378:403.

136. Sepehry AA, Lee PE, Hsiung GY, et al. Effect of selective serotonin reuptake inhibitors in Alzheimer's disease with comorbid depression: a meta-analysis of depression and cognitive outcomes. Drugs Aging 2012; 29:793.

137. Taragano FE, Lyketsos CG, Mangone CA, et al. A double-blind, randomized, fixed-dose trial of fluoxetine vs. amitriptyline in the treatment of major depression complicating Alzheimer's disease. Psychosomatics 1997; 38:246.

138. Clarke DE, Ko JY, Lyketsos C, et al. Apathy and cognitive and functional decline in community-dwelling older adults: results from the Baltimore ECA longitudinal study. Int Psychogeriatr 2010; 22:819.

139. Onyike CU, Sheppard JM, Tschanz JT, et al. Epidemiology of apathy in older adults: the Cache County Study. Am J Geriatr Psychiatry 2007; 15:365.

140. Okura T, Plassman BL, Steffens DC, et al. Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: The aging, demographics, and memory study. J Am Geriatr Soc 2010; 58:330.

141. Lavretsky H, Reinlieb M, St Cyr N, et al. Citalopram, methylphenidate, or their combination in geriatric depression: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry 2015; 172:561.

142. Padala PR, Burke WJ, Shostrom VK, et al. Methylphenidate for apathy and functional status in dementia of the Alzheimer type. Am J Geriatr Psychiatry 2010; 18:371.

143. Padala PR, Padala KP, Lensing SY, et al. Methylphenidate for Apathy in Community-Dwelling Older Veterans With Mild Alzheimer's Disease: A Double-Blind, Randomized, Placebo-Controlled Trial. Am J Psychiatry 2018; 175:159.

144. Herrmann N, Rothenburg LS, Black SE, et al. Methylphenidate for the treatment of apathy in Alzheimer disease: prediction of response using dextroamphetamine challenge. J Clin Psychopharmacol 2008; 28:296.

145. Rosenberg PB, Lanctôt KL, Drye LT, et al. Safety and efficacy of methylphenidate for apathy in Alzheimer's disease: a randomized, placebo-controlled trial. J Clin Psychiatry 2013; 74:810.

146. Deschenes CL, McCurry SM. Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep 2009; 11:20.

147. Phillips VL, Diwan S, Egner A. Development of a tool for assessment and care planning for dementia-related problem behaviors in home and community-based services programs: the Problem Behavior Inventory. Home Health Care Serv Q 2002; 21:29.

148. Alagiakrishnan K, Lim D, Brahim A, et al. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J 2005; 81:463.

149. Tsai SJ, Hwang JP, Yang CH, et al. Inappropriate sexual behaviors in dementia: a preliminary report. Alzheimer Dis Assoc Disord 1999; 13:60.

150. Zeiss AM, Davies HD, Tinklenberg JR. An observational study of sexual behavior in demented male patients. J Gerontol A Biol Sci Med Sci 1996; 51:M325.

151. Ozkan B, Wilkins K, Muralee S, Tampi RR. Pharmacotherapy for inappropriate sexual behaviors in dementia: a systematic review of literature. Am J Alzheimers Dis Other Demen 2008; 23:344.

152. Prakash R, Pathak A, Munda S, Bagati D. Quetiapine effective in treatment of inappropriate sexual behavior of lewy body disease with predominant frontal lobe signs. Am J Alzheimers Dis Other Demen 2009; 24:136.

153. Anneser JM, Jox RJ, Borasio GD. Inappropriate sexual behaviour in a case of ALS and FTD: successful treatment with sertraline. Amyotroph Lateral Scler 2007; 8:189.

154. Black B, Muralee S, Tampi RR. Inappropriate sexual behaviors in dementia. J Geriatr Psychiatry Neurol 2005; 18:155.

155. Guay DR. Inappropriate sexual behaviors in cognitively impaired older individuals. Am J Geriatr Pharmacother 2008; 6:269.

156. Light SA, Holroyd S. The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. J Psychiatry Neurosci 2006; 31:132.

157. Aarsland D, Brønnick K, Ehrt U, et al. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 2007; 78:36.

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Management of neuropsychiatric symptoms of dementia - UpToDate

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Management of neuropsychiatric symptoms of dementia INTRODUCTION Neuropsychiatric symptoms in Alzheimer disease (AD) and other types of dementia are extremely common and often much more troubling than cognitive symptoms [ 1]. This topic will review the causes and treatment of behavioral disturbance and other neuropsychiatric symptoms related to dementia.

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Dr. Daniel PressMichael Alejandro, MD. Inhibidores de la colinesterasa en el tratamiento de la demencia. 21 de junio de 2021. UpToDate. Disponible en: https://www.uptodate.com/contents/cholinesterase-inhibitors-in-the-treatment-of-dementia?search=demencia%20ancianos&topicRef=5082&source=see_link

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Cholinesterase inhibitors in the treatment of dementia

INTRODUCTION

Cholinesterase inhibitors and memantine are the only currently available symptomatic medications for cognition and global functioning in patients with dementia. Cholinesterase inhibitors target the acetylcholine deficit arising from loss of neurons in the nucleus basalis of Meynert and its projections in patients with dementia. They are considered symptomatic therapies and are not believed to be neuroprotective or to alter the underlying disease trajectory.

This topic will discuss the use of cholinesterase inhibitors in the treatment of dementia. Topics on other aspects of the treatment of dementia include:

●(See "Treatment of Alzheimer disease".)

●(See "Management of neuropsychiatric symptoms of dementia".)

●(See "Management of the patient with dementia".)

Literature review current through: May 2022. | This topic last updated: Jun 21, 2021.

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2022 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

REFERENCES

1. Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA 2004; 292:2901.

2. Erkinjuntti T, Kurz A, Gauthier S, et al. Efficacy of galantamine in probable vascular dementia and Alzheimer's disease combined with cerebrovascular disease: a randomised trial. Lancet 2002; 359:1283.

3. Kumar V, Anand R, Messina J, et al. An efficacy and safety analysis of Exelon in Alzheimer's disease patients with concurrent vascular risk factors. Eur J Neurol 2000; 7:159.

4. Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1154.

5. Guideline Watch (October 2014): Practice guideline for the treatment of patients with Alzheimer's disease and other dementias. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimerwatch.pdf.

6. Gauthier S, Patterson C, Chertkow H, et al. 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Can J Neurol Sci 2012; 39:S1.

7. NICE Guidance: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. https://www.nice.org.uk/guidance/ta217/chapter/1-Guidance.

8. O'Brien JT, Burns A, BAP Dementia Consensus Group. Clinical practice with anti-dementia drugs: a revised (second) consensus statement from the British Association for Psychopharmacology. J Psychopharmacol 2011; 25:997.

9. Hort J, O'Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer's disease. Eur J Neurol 2010; 17:1236.

10. Sorbi S, Hort J, Erkinjuntti T, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol 2012; 19:1159.

11. Wilcock G, Howe I, Coles H, et al. A long-term comparison of galantamine and donepezil in the treatment of Alzheimer's disease. Drugs Aging 2003; 20:777.

12. Ancoli-Israel S, Amatniek J, Ascher S, et al. Effects of galantamine versus donepezil on sleep in patients with mild to moderate Alzheimer disease and their caregivers: a double-blind, head-to-head, randomized pilot study. Alzheimer Dis Assoc Disord 2005; 19:240.

13. Bullock R, Bergman H, Touchon J, et al. Effect of age on response to rivastigmine or donepezil in patients with Alzheimer's disease. Curr Med Res Opin 2006; 22:483.

14. Bullock R, Touchon J, Bergman H, et al. Rivastigmine and donepezil treatment in moderate to moderately-severe Alzheimer's disease over a 2-year period. Curr Med Res Opin 2005; 21:1317.

15. Campbell NL, Perkins AJ, Gao S, et al. Adherence and Tolerability of Alzheimer's Disease Medications: A Pragmatic Randomized Trial. J Am Geriatr Soc 2017; 65:1497.

16. Cui CC, Sun Y, Wang XY, et al. The effect of anti-dementia drugs on Alzheimer disease-induced cognitive impairment: A network meta-analysis. Medicine (Baltimore) 2019; 98:e16091.

17. Wilkinson DG, Passmore AP, Bullock R, et al. A multinational, randomised, 12-week, comparative study of donepezil and rivastigmine in patients with mild to moderate Alzheimer's disease. Int J Clin Pract 2002; 56:441.

18. Farlow MR, Salloway S, Tariot PN, et al. Effectiveness and tolerability of high-dose (23 mg/d) versus standard-dose (10 mg/d) donepezil in moderate to severe Alzheimer's disease: A 24-week, randomized, double-blind study. Clin Ther 2010; 32:1234.

19. Rogers SL, Farlow MR, Doody RS, et al. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Donepezil Study Group. Neurology 1998; 50:136.

20. Doody RS, Geldmacher DS, Gordon B, et al. Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer disease. Arch Neurol 2001; 58:427.

21. Mohs RC, Doody RS, Morris JC, et al. A 1-year, placebo-controlled preservation of function survival study of donepezil in AD patients. Neurology 2001; 57:481.

22. Winblad B, Engedal K, Soininen H, et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology 2001; 57:489.

23. Hernandez RK, Farwell W, Cantor MD, Lawler EV. Cholinesterase inhibitors and incidence of bradycardia in patients with dementia in the veterans affairs new England healthcare system. J Am Geriatr Soc 2009; 57:1997.

24. Gill SS, Anderson GM, Fischer HD, et al. Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: a population-based cohort study. Arch Intern Med 2009; 169:867.

25. http://www.hc-sc.gc.ca/dhp-mps/medeff/reviews-examens/aricept-eng.php.

26. Mayor S. Regulatory authorities review use of galantamine in mild cognitive impairment. BMJ 2005; 330:276.

27. Winblad B, Cummings J, Andreasen N, et al. A six-month double-blind, randomized, placebo-controlled study of a transdermal patch in Alzheimer's disease--rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007; 22:456.

28. Winblad B, Grossberg G, Frölich L, et al. IDEAL: a 6-month, double-blind, placebo-controlled study of the first skin patch for Alzheimer disease. Neurology 2007; 69:S14.

29. Isaacson RS, Ferris S, Velting DM, Meng X. Cognitive Efficacy (SIB) of 13.3 Versus 4.6 mg/24 h Rivastigmine Patch in Severe Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2016; 31:270.

30. Novartis Exelon labeling update reflects report of esophageal rupture. The Pink Sheet 2001; 63:24.

31. Feldman HH, Lane R, Study 304 Group. Rivastigmine: a placebo controlled trial of twice daily and three times daily regimens in patients with Alzheimer's disease. J Neurol Neurosurg Psychiatry 2007; 78:1056.

32. Regenold WT, Loreck DJ, Brandt N. Prescribing Cholinesterase Inhibitors for Alzheimer Disease: Timing Matters. Am Fam Physician 2018; 97:700.

33. Sheffrin M, Miao Y, Boscardin WJ, Steinman MA. Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System. J Am Geriatr Soc 2015; 63:1512.

34. Soysal P, Isik AT, Stubbs B, et al. Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87:1368.

35. Kim DH, Brown RT, Ding EL, et al. Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J Am Geriatr Soc 2011; 59:1019.

36. Miranda LF, Gomes KB, Silveira JN, et al. Predictive factors of clinical response to cholinesterase inhibitors in mild and moderate Alzheimer's disease and mixed dementia: a one-year naturalistic study. J Alzheimers Dis 2015; 45:609.

37. Xiao T, Jiao B, Zhang W, et al. Effect of the CYP2D6 and APOE Polymorphisms on the Efficacy of Donepezil in Patients with Alzheimer's Disease: A Systematic Review and Meta-Analysis. CNS Drugs 2016; 30:899.

38. Chianella C, Gragnaniello D, Maisano Delser P, et al. BCHE and CYP2D6 genetic variation in Alzheimer's disease patients treated with cholinesterase inhibitors. Eur J Clin Pharmacol 2011; 67:1147.

39. Pilotto A, Franceschi M, D'Onofrio G, et al. Effect of a CYP2D6 polymorphism on the efficacy of donepezil in patients with Alzheimer disease. Neurology 2009; 73:761.

40. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet 2017; 390:2673.

41. Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease. N Engl J Med 2012; 366:893.

42. Howard R, McShane R, Lindesay J, et al. Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINO-AD) trial: secondary and post-hoc analyses. Lancet Neurol 2015; 14:1171.

43. Holmes C, Wilkinson D, Dean C, et al. The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology 2004; 63:214.

44. Rainer M, Mucke HA, Krüger-Rainer C, et al. Cognitive relapse after discontinuation of drug therapy in Alzheimer's disease: cholinesterase inhibitors versus nootropics. J Neural Transm (Vienna) 2001; 108:1327.

45. O'Regan J, Lanctôt KL, Mazereeuw G, Herrmann N. Cholinesterase inhibitor discontinuation in patients with Alzheimer's disease: a meta-analysis of randomized controlled trials. J Clin Psychiatry 2015; 76:e1424.

46. Pariente A, Fourrier-Réglat A, Bazin F, et al. Effect of treatment gaps in elderly patients with dementia treated with cholinesterase inhibitors. Neurology 2012; 78:957.

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Cholinesterase inhibitors in the treatment of dementia - UpToDate

# data[].attributes.attachment_link.description
Cholinesterase inhibitors in the treatment of dementia INTRODUCTION Cholinesterase inhibitors and memantine are the only currently available symptomatic medications for cognition and global functioning in patients with dementia. Cholinesterase inhibitors target the acetylcholine deficit arising from loss of neurons in the nucleus basalis of Meynert and its projections in patients with dementia.

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Utilizados para el tratamiento de la demencia: dosis y forma de administración

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Quesada Astorga D. Delirium en el adulto mayor. Revista médica de Costa Rica y Centro américa. LXXII. (614). 3 - 7, 2015. Disponible en: https://www.medigraphic.com/pdfs/revmedcoscen/rmc-2015/rmc151b.pdf

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Por convención, el haloperidol ha sido el agente de elección para el tratamiento del delirio.

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Steven T. Debekosky.Kennet E. Schmander.Evaluación del deterioro cognitivo y la demencia.mayo 2022. UpToDate. Disponible en: https://www.uptodate.com/contents/evaluation-of-cognitive-impairment-and-dementia/print?search=demencia%20en%20el%20adulto%20mayor&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H14
Al-Zahrani JM. Prevention of dementia in elderly population: A comprehensive review of literature. Ann Indian Psychiatry 2019;3:14-8. Disponible en: file:///C:/Users/LIZBETH/Downloads/Prevention_of_dementia_in_elderly_population_A_com.pdf

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Evaluation of cognitive impairment and dementia - UpToDate

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Dementia is a disorder that is characterized by a decline in cognition involving one or more cognitive domains (learning and memory, language, executive functio

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Se elegirá el fármaco adecuado según el perfil  de efectos secundarios, el estado del paciente y la vía elegida de administración.

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El tratamiento farmacológico debe reservarse para los pacientes que son una amenaza para su propia seguridad y la de los demás.

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Tratar la causa de base, controlando simultáneamente los síntomas del síndrome confucional.

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Manejo farmacológico

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Asegurar la vía aérea, mantenimiento de las constantes vitales, canalizar una vía venosa, suspender fármacos sospechosos de causar el síndrome confucional, proporcionar un aporte nutritivo, mantener un adecuado equilibrio hidroelectrolítico y evitar lesiones.

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Evite pedirle a la persona que haga lo que parece desencadenar una respuesta agitada o agresiva.

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Otras pruebas (evaluación neuropsicológica, técnicas avanzadas de neuroimagen, punción lumbar [PL] y, en raras ocasiones, biopsia cerebral) se realizan en pacientes seleccionados (como los que son más jóvenes o tienen un curso rápidamente progresivo) y cuando la presentación es por lo demás atípica.

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Valide que la persona parece estar molesta por algo. Asegúrele a la persona que quiere ayudar y que la ama.

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Si parece que usted es la causa del problema, abandone la habitación por un rato.

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Como la mayoría de las causas de demencia son progresivas, una visita de seguimiento después de varios meses a menudo puede confirmar el diagnóstico original, puede ofrecer un tratamiento y control continuos y, en algunos casos, puede hacer que un médico reconsidere el diagnóstico original si la progresión no mejora. ocurre o es atípica.

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Redirija a la persona para que participe en una actividad agradable u ofrézcale comida reconfortante que pueda reconocer y que le guste.

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Evite señalar con el dedo, regañar o amenazar.

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Hable despacio y con calma en un tono de voz normal. Es posible que la persona no entienda las palabras pronunciadas, pero puede captar el tono de voz detrás de las palabras y responder a eso.

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Interacción física: mantenga el contacto visual, llegue a su altura y deje espacio.

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No estés en desacuerdo; Respete los pensamientos de la persona, incluso si son incorrectos.

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La historia y el examen junto con pruebas de laboratorio limitadas y un estudio de neuroimagen suelen ser suficientes para hacer un diagnóstico de demencia y, en la mayoría de los casos, para identificar una causa presuntiva.

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Viaja con ellos a donde están en el tiempo

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Todas las personas de edad avanzada que presenten un cuadro de delirium, requieren una serie de análisis básicos

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Los propósitos de las imágenes estructurales son detectar causas tratables de demencia y diferenciar entre varios subtipos de demencia.

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Revise los medicamentos, especialmente los nuevos.

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Laboratorio

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En la evaluación inicial de todos los pacientes con demencia, se debe considerar la realización de neuroimágenes con resonancia magnética nuclear (RMN) sin contraste o tomografía computarizada (TC) de la cabeza.

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Evaluar la presencia de dolor, estreñimiento u otro problema físico.

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Los datos limitados sugieren que el tratamiento de las deficiencias puede mejorar la cognición.

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Separe a la persona de lo que parece estar molestándola.

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Actividad de rutina

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Métodos psicométricos como el Confusion Assessment Method (CAM)

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Se recomienda la detección de la deficiencia de vitamina B12 y el hipotiroidismo para los pacientes que están siendo evaluados para la demencia.

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Criterios diagnósticos propuestos por la Asociación Americana de Psiquiatría

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Historia clínica detallada del paciente o referida por familiares y un examen físico y neurológico completo

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Se recomienda la detección de depresión en pacientes con demencia porque la depresión es una comorbilidad tratable común que también puede enmascararse como demencia.

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Una breve evaluación de detección como el Mini-Examen del Estado Mental (MMSE) o la Evaluación Cognitiva de Montreal (MoCA) es útil y puede ser una evaluación cognitiva suficiente en algunos pacientes

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Diagnóstico sindrómico, reconocer que el paciente está realmente confuso.

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Se debe programar el tiempo adecuado para una evaluación completa de la función cognitiva, seguida de un examen físico completo, incluido el examen neurológico.

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Supone el 35-50% de los síndromes confusionales. Alternan la hiper e hipoactividad en el tiempo

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Los familiares u otros informantes que conocen bien al paciente son recursos invaluables para proporcionar un historial adecuado de cambios cognitivos y conductuales. Un historial de medicamentos es particularmente importante, ya que muchos medicamentos pueden afectar la cognición en pacientes mayores.

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Es el tipo de delirium que se desarrolla en las alteracione smetabólicas

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El paso inicial en la evaluación de un paciente con sospecha de demencia debe centrarse en la historia.

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Diagnóstico diferencial con la demencia y la depresión.

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Enlentecimiento psicomotor, bradipsiquia, lenguaje lento, inexpresividad facial, letargia, actitud apática, inhibición.

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Suele asociarse a abstinencia o intoxicación por tóxicos y al efecto anticolinérgico de fármacos.

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Agitación

Agresividad

Confusión

Alucinaciones

Ideación delirante

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Mixto

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Hipoactivo

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Hiperactivo

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Las características clave del delirium son su inicio agudo y falta de atención.

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Brüning  K.  Depresión en aultos mayores: una mirada desde la medicina familiar. [Internet] 2019. [Consultado el 1 de julio de 2022]. Disponible en: https://medicina.uc.cl/wp-content/uploads/2019/08/Articulo-Depresion-en-AM-Bruning.pdf

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El olvido es la queja principal más común; además, los pacientes con demencia también tienen dificultad con uno o más de los siguientes

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La persistencia de factores que afecten alguno de estos ámbitos, se traduce en un círculo vicioso que dificulta el tratamiento eficaz de la depresión. Refleja la necesidad de un abordaje multidisciplinario. Es importante mencionar la relevancia de las intervenciones psicológicas; sin embargo, no es el objetivo de este artículo desarrollar este ámbito.

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El modelo conceptual llamado “el ciclo de la depresión” es de utilidad para explicar cómo un síntoma puede estar relacionado a otro, y qué aspectos deben ser tratados, para lograr un manejo integral de la patología.

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Actividad anticolinérgica (antihistamínicos, relajantes musculares, antipsicóticos), benzodiacepinas, agonistas dopaminergicos, ansiolíticos, narcóticos.

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-Retención de nueva información (p. ej., dificultad para recordar eventos)

-Manejar tareas complejas (p. ej., cuadrar una chequera)

-Razonamiento (p. ej., incapaz de hacer frente a eventos inesperados)

-Habilidad espacial y orientación (p. ej., perderse en lugares familiares)

-Idioma (p. ej., búsqueda de palabras)

-Comportamiento

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En algunos casos se sugiere mantener el tratamiento de forma indefinida, con el objetivo de evitar recurrencias: depresión recurrente, depresión grave, remisión parcial de síntomas, necesidad de varios fármacos para lograr remisión. Lo anterior considerando siempre las preferencias del paciente, factores de riesgo de depresión y efectos adversos de los fármacos.

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No hay consenso, pero en distintas publicaciones se sugiere al menos poder contar con TSH, hematocrito/hemoglobina, vitamina B12, folato y glicemia en ayunas (recomendación clase D).

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Eventos agudos: deshidratación, fracturas, hipoxia, infecciones, isquemia, medicamentos y trastornos metabólicos.

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La presencia de síntomas neuropsiquiátricos conduce a un mayor deterioro funcional en pacientes con demencia

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Síndromes de demencia

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Una vez alcanzada la remisión de los síntomas depresivos, se recomienda mantener el tratamiento al menos durante 12 meses, para disminuir las recurrencias.

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Comorbilidades: alcoholismo, dolor crónico, historia de enfermedad pulmonar, hepática, cardiaca o cerebral, enfermedad terminal.

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Se sugiere intentar siempre un abordaje familiar entrevistando a un acompañante por posible bajo reporte de síntomas depresivos y/o alteraciones de memoria

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Encaminado en manejar síntomas neuropsiquiátricos relacionados con la demencia

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Demencia por enfermedad de Parkinson

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Deterioro cognitivo preexistente o demencia, edad avanzada

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Control de sodio plasmático al mes de inicio de ISRS (recomendación clase C). Aproximadamente un 8% de quienes inicien ISRS desarrollará hiponatremia, relacionada a SSIADH, reversible.
ECG de base (y de control en caso de QT límite en ECG basal o uso de otros fármacos con riesgo de prolongación del QT) en caso de uso de cilalopram o escitalopram. Evitar estos fármacos en dosis alta.

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Demencia frontotemporal

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Inducido por fármacos

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Demencia con cuerpos de Lewy

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Enfermedad de Alzheimer

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Precipitantes

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Predisponentes

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La mayoría de las demencias son causadas por una enfermedad neurodegenerativa

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Hasta un 31% durante la hospitalización (incidencia)

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Delirio en hasta un 22% de pacientes adultos mayores al ingreso (prevalencia)

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o Son menos frecuentes las consultas por ánimo disminuido.
o Con mayor frecuencia consultan por síntomas físicos o cognitivos, irritabilidad o ansiedad.
o Los síntomas suelen ser atribuidos a otras patologías, parte del envejecimiento o demencia.

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Utilizando los criterios diagnósticos del DSM se ha encontrado:

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Más común en personas mayores en hospitales y centros de atención a largo plazo.

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Si bien el diagnóstico de la depresión en adultos mayores se realiza de acuerdo a los criterios DSM-5 (ver Tabla 2), hay ciertas particularidades en la forma de presentación