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Alzheimer hastalığındaki nöropsikiyatrik semptomların yönetiminde güncel gelişmeler: Sistematik derleme

Year 2025, Volume: 30 Issue: 2, 302 - 316, 29.05.2025

Doğancan Sönmez , Çiçek Hocaoğlu

https://doi.org/10.21673/anadoluklin.1476946

Abstract

Alzheimer hastalığı, bilişsel ve işlevsel bozulmalarla birlikte yaygın olarak nöropsikiyatrik semptomları içeren ilerleyici bir nörodejeneratif bozukluktur. Bu semptomlar arasında ajitasyon, depresyon ve anksiyete belirtileri, halüsinasyonlar, sanrılar, uyku bozuklukları ve davranışsal değişiklikler bulunmaktadır. Tedavide farmakoterapi, psikososyal müdahaleler ve çevresel düzenlemelerin bir kombinasyonu kullanılmaktadır. Nöropsikiyatrik semptomların tedavisinde ilaç dışı yaklaşımlar önemli bir yer tutar. İlaç tedavisi gerekli olsa da psikososyal ve çevresel düzenlemeler de kritik öneme sahiptir ve genellikle ilaç tedavisinden önce veya ilaç tedavisiyle birlikte uygulanmalıdır. Tedavide kullanılan ilaçlar arasında kolinesteraz inhibitörleri, NMDA reseptör antagonistleri, antipsikotikler, antidepresanlar ve anksiyolitikler bulunmaktadır. Bununla birlikte, farmakoterapinin yan etkileri ve etkinliği göz önünde bulundurulmalıdır. Psikososyal müdahaleler arasında eğitim, destek grupları, davranışsal terapiler ve ortam değişiklikleri yer almaktadır. Ayrıca, hasta ve bakım verenler için kaynakları kolaylaştırmak ve desteklemek önemlidir. Bu semptomların yönetiminde multidisipliner bir yaklaşım gereklidir ve bireyselleştirilmiş bir tedavi planı oluşturulmalıdır. Sonuç olarak, Alzheimer hastalığında nöropsikiyatrik semptomların etkili bir şekilde tedavi edilmesi ve yönetilmesi, hasta yaşam kalitesini ve bakım deneyimini önemli ölçüde artırabilir. Bu derleme çalışmasında Alzheimer hastalarında görülen nöropsikiyatrik semptomların patofizyolojisi, tanı ve güncel tedavi algoritmaları hakkında güncel literatür bilgileri ile tartışılacaktır.

Keywords

Alzheimer hastalığı demans nöropsikiyatri tedavi

References

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Current developments in the management of neuropsychiatric symptoms in Alzheimer’s Disease: A systematic review

Year 2025, Volume: 30 Issue: 2, 302 - 316, 29.05.2025

Doğancan Sönmez , Çiçek Hocaoğlu

https://doi.org/10.21673/anadoluklin.1476946

Abstract

Alzheimer’s disease is a progressive neurodegenerative disorder that commonly involves neuropsychiatric symptoms along with cognitive and functional impairments. These symptoms include agitation, symptoms of depression and anxiety, hallucinations, delusions, sleep disturbances, and behavioral changes. A combination of pharmacotherapy, psychosocial interventions and environmental regulations are used in treatment. Nonpharmacological approaches play an important role in the treatment of neuropsychiatric symptoms. Although drug therapy is necessary, psychosocial and environmental adjustments are also critical and should generally be implemented before or in conjunction with drug therapy. Medications used include cholinesterase inhibitors, NMDA receptor antagonists, antipsychotics, antidepressants and anxiolytics. However, side effects and effectiveness of pharmacotherapy should be considered. Psychosocial interventions include education, support groups, behavioral therapies, and environment changes. Additionally, it is important to facilitate and support resources for patients and caregivers. A multidisciplinary approach is required in the management of these symptoms and an individualized treatment plan should be created. In conclusion, effectively treating and managing neuropsychiatric symptoms in Alzheimer’s disease can significantly improve patient quality of life and experience of care. In this review study, the pathophysiology of neuropsychiatric symptoms seen in Alzheimer’s patients will be discussed with current literature information about diagnosis and current treatment algorithms.

Keywords

Alzheimer dementia neuropsychiatry treatment

References

  • Wong W. Economic burden of Alzheimer disease and managed care considerations. Am J Manag Care. 2020;26(8 Suppl):177-83.
  • Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer’s disease: challenges and advances in diagnosis and treatment. Front Neurosci. 2023;17:1263771.
  • Clement A, Wiborg O, Asuni AA. Steps towards developing effective treatments for neuropsychiatric disturbances in alzheimer’s disease: insights from preclinical models, clinical data, and future directions. Front Aging Neurosci. 2020;12:56.
  • Teixeira AL, Rocha NP, Gatchel J. Behavioral or neuropsychiatric symptoms of Alzheimer’s disease: from psychopathology to pharmacological management. Arq Neuropsiquiatr. 2023;81(12):1152-62.
  • Zhao QF, Tan L, Wang HF, et al. The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: Systematic review and meta-analysis. J Affect Disord. 2016;190:264-71.
  • Brodaty H, Connors MH, Xu J, Woodward M, Ames D; PRIME study group. The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. J Am Med Dir Assoc. 2015;16(5):380-7.
  • Gumus M, Multani N, Mack ML, Tartaglia MC. Progression of neuropsychiatric symptoms in young-onset versus late-onset Alzheimer’s disease. GeroScience. 2021;43(1):213-23.
  • Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475-83.
  • Eikelboom WS, van den Berg E, Singleton EH, et al. Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations. Neurology. 2021;97(13):e1276-87.
  • Chen Y, Dang M, Zhang Z. Brain mechanisms underlying neuropsychiatric symptoms in Alzheimer’s disease: a systematic review of symptomgeneral and specific lesion patterns. Mol Neurodegener. 2021;16(1):38.
  • Meeks TW, Ropacki SA, Jeste DV. The neurobiology of neuropsychiatric syndromes in dementia. Curr Opin Psychiatry. 2006;19(6):581-6.
  • Rosenberg PB, Nowrangi MA, Lyketsos CG. Neuropsychiatric symptoms in Alzheimer’s disease: What might be associated brain circuits? Mol Aspects Med. 2015;43:25-37.
  • Bruen PD, McGeown WJ, Shanks MF, Venneri A. Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer’s disease. Brain. 2008;131(Pt 9):2455-63.
  • Guo Y, Sun Y, Li M, et al. Amyloid Pathology Modulates the Associations of Neuropsychiatric Symptoms with Cognitive Impairments and Neurodegeneration in Non-Demented Elderly. J Alzheimers Dis. 2024;97(1):471-84.
  • Ribeiro DE, Petiz LL, Glaser T, et al. Purinergic signaling in cognitive impairment and neuropsychiatric symptoms of Alzheimer’s disease. Neuropharmacology. 2023;226:109371.
  • Tahami Monfared AA, Byrnes MJ, White LA, Zhang Q. Alzheimer’s Disease: Epidemiology and Clinical Progression. Neurol Ther. 2022;11(2):553-69.
  • Wolinsky D, Drake K, Bostwick J. Diagnosis and management of neuropsychiatric symptoms in Alzheimer’s disease. Curr Psychiatry Rep. 2018;20(12):117.
  • Mehak SF, Shivakumar AB, Saraf V, Johansson M, Gangadharan G. Apathy in Alzheimer’s disease: A neurocircuitry based perspective. Ageing Res Rev. 2023;87:101891.
  • Kitamura S, Shimada H, Niwa F, et al. Tau-induced focal neurotoxicity and network disruption related to apathy in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2018;89(11):1208-14.
  • Starkstein SE, Brockman S. The neuroimaging basis of apathy: Empirical findings and conceptual challenges. Neuropsychologia. 2018;118(Pt B):48-53.
  • Ota M, Sato N, Nakata Y, Arima K, Uno M. Relationship between apathy and diffusion tensor imaging metrics of the brain in Alzheimer’s disease. Int J Geriatr Psychiatry. 2012;27(7):722-6.
  • Breitve MH, Brønnick K, Chwiszczuk LJ, Hynninen MJ, Aarsland D, Rongve A. Apathy is associated with faster global cognitive decline and early nursing home admission in dementia with Lewy bodies. Alzheimers Res Ther. 2018;10(1):83.
  • Padala PR, Boozer EM, Lensing SY, et al. Neuromodulation for apathy in alzheimer’s disease: a double-blind, randomized, sham-controlled pilot study. J Alzheimers Dis. 2020;77(4):1483-93.
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Details

Primary Language Turkish
Subjects Psychiatry
Journal Section REVİEW
Authors

Doğancan Sönmez 0000-0003-0937-8264

Çiçek Hocaoğlu 0000-0001-6613-4317

Publication Date May 29, 2025
Submission Date May 1, 2024
Acceptance Date July 29, 2024
Published in Issue Year 2025 Volume: 30 Issue: 2

Cite

Vancouver Sönmez D, Hocaoğlu Ç. Alzheimer hastalığındaki nöropsikiyatrik semptomların yönetiminde güncel gelişmeler: Sistematik derleme. Anatolian Clin. 2025;30(2):302-16.
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