Gene/Protein Disease Symptom Drug Enzyme Compound
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 4,089 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuropsychiatric abnormalities, as well as the commonly associated neuropsychological symptoms, are clinical characteristics of Alzheimer's disease (AD), the most common form of dementia. Thus, in addition to a general cognitive and functional decline, neuropsychiatric manifestations, such as agitation, apathy, anxiety, psychoses and disinhibition, are frequently evident in AD patients. Such neuropsychiatric symptoms of AD are the source of considerable patient and caregiver distress, resulting in the prescription of neuroleptics, benzodiazepines or other psychotropic agents, and are a major factor in the decision to transfer the care of patients into nursing homes. Recent evidence suggests that some neuropsychiatric changes associated with AD are related to the cholinergic deficits in the brains of AD patients and that such abnormalities may be responsive to cholinergic therapy. Cholinergic drug therapies indicated for the symptomatic treatment of AD, for example tacrine and the newer cholinesterase (ChE) inhibitors such as donepezil, have been demonstrated to improve memory, language and praxis. Furthermore, although less is known about the effect of ChE inhibitors on the neuropsychiatric symptoms of AD, preliminary evidence suggests that they reduce apathy, anxiety, hallucinations, disinhibition and aberrant motor behaviour. Thus, the newer-generation ChE inhibitors that are well tolerated, easy to administer and show promise in reducing the cognitive, as well as neuropsychiatric disturbances of AD, may emerge as important treatments for some neuropsychiatric symptoms in patients with central cholinergic deficits, including AD.
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PMID:Neuropsychiatric symptoms and cholinergic therapy for Alzheimer's disease. 987 14

The purpose of this study was to investigate noncognitive symptoms in Alzheimer disease to identify symptom patterns and to study stability of such patterns prospectively. Furthermore, variables were examined that could be associated with certain types of symptom patterns or could be predictors of change of these patterns. Forty-eight patients with the clinical diagnosis of probable Alzheimer disease were included in this study and were assessed weekly over a 3-week period. Noncognitive symptoms were rated according to the Behavioral Abnormalities in Alzheimer's Disease Rating Scale and the Dementia Mood Assessment Scale and to a set of items that specifically assess misidentifications. By means of principal component factor analysis different noncognitive symptom patterns were obtained, yielding a four-factor solution. They mapped onto rational domains with respect to clinical experience: depression, apathy, psychotic symptoms/aggression, and misidentifications/agitation. Demographic and clinical variables were not associated with the factor solutions and did not predict change of the factor values. The results demonstrate that in Alzheimer disease there are distinct noncognitive symptom patterns that hold at least short-term prospective stability. None of the examined clinical variables, such as age at entry, the status of the patients (outpatient or inpatient), or dementia severity, exerted substantial influence on the noncognitive symptom patterns. Further investigations should concentrate on the pathological and prognostic correlates of noncognitive symptom patterns in Alzheimer disease.
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PMID:Presentation and stability of noncognitive symptom patterns in patients with Alzheimer disease. 987 60

The range of neuropsychiatric symptoms in multiple sclerosis (MS) has not been prospectively assessed. The authors, working at a tertiary medical center in Mexico City, used the Neuropsychiatric Inventory (NPI) to evaluate neuropsychiatric symptoms prospectively in 44 MS patients who were stable between relapses and 25 control subjects of similar age, education, and cognitive function. Neuropsychiatric symptoms were present in 95% of patients and 16% of control subjects. Changes present were depressive symptoms (79%), agitation (40%), anxiety (37%), irritability (35%), apathy (20%), euphoria (13%), disinhibition (13%), hallucinations (10%), aberrant motor behavior (9%), and delusions (7%). The only relationships with MRI were between euphoria and hallucinations and moderately severe MRI abnormalities. The authors conclude that diverse types of neuropsychiatric symptoms are common in MS; symptoms are present between exacerbations; and there are variable correlations with MRI abnormalities.
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PMID:Neuropsychiatric manifestations of multiple sclerosis. 999 May 56

Logistic regression is used to examine why formal home health service recommendations are made to Alzheimer's disease patients (N = 822) by staff at each of six Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs) in California. Patients are selected on the basis of their having Alzheimer's disease, and not having any physical co-morbid health problems noted at the time of their clinical assessment. Using Medicare Part A to pay for care, previous home health use, having regular access to and prior use of a primary care physician, prior hospitalization, client agitation and apathy, and family's social isolation were significant predictors of the latent propensity to recommend formal home health services to members of this sample.
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PMID:Why home health services are provided to Alzheimer's disease patients in California's Alzheimer's disease program: an exploration. 1017 35

Frontotemporal dementia (FTD) was diagnosed in 74 outpatients with a standardized assessment including neuropsychological tests, behavioural scale, structural and functional imaging. Clinical characteristics were consistent with the literature data. The cohort was followed for 2-6 years to determine the reliable variable for evaluating the progression of FTD. Every fourth patient died after a mean duration of 7 years. At first, FTD manifests itself in behavioural changes with relatively stable global cognition although language, verbal fluency and memory tests were reliable tools to follow the progression of the disease. Below 18 of Mini-Mental State Examination, mutism and apathy prevented from neuropsychological testing within the next 6 months. Behavioural disorders evolved with time but restlessness and hyperorality were long-lasting. Imaging showed the progression of a consistent pattern of anterior abnormalities with frequent leukoaraiosis.
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PMID:The clinical picture of frontotemporal dementia: diagnosis and follow-up. 1043 34

Behavioural symptoms are not crucial for a valid diagnosis of dementia. However, these symptoms are important determinants of the burden of caregivers and strongly predict premature nursing home placement. Agitation, apathy, and depression are most prevalent, whereas aggressive behaviour, delusions and hallucinations are less frequent. Among the behavioural symptoms of dementia agitation is the most persistent problem. Psychosocial treatment basically requests a constant and empathetic relationship between therapist and patient or caregiver. Recent studies have demonstrated that specific treatment interventions are effective in reducing behavioural symptoms, such as agitation, apathy, and depression. Psychoeducative strategies in the support of caregivers may be effective in reducing behavioural symptoms of the demented patients in daily living.
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PMID:[The course of behavior disorders and their psychosocial treatment in patients with dementia]. 1043 95

The introduction of acetylcholinesterase inhibitors has greatly improved therapeutic opportunities for patients with dementia, in particular with Alzheimer's disease. The most likely outcome of treatment with these compounds is a maintenance of cognitive ability and/or activities of daily living over at least 6 months. Regarding the progressive nature of the underlying neurodegenerative process a temporary stabilization of symptoms is a clear treatment success. Approximately 25 per cent of patients experience a significant improvement in cognitive ability. They show more attentiveness, interest, activity, orientation, communicative ability, as well as better memory. In addition, the new medications can ameliorate non-cognitive symptoms including apathy, agitation, delusions, hallucinations, and disinhibition. Open-label long-term studies have demonstrated that patients receiving treatment with an acetylcholinesterase inhibitor cross their baseline cognitive ability at week 40 to 50 and continue to decline thereafter. In spite of this slow deterioration treated patients perform better than untreated individuals. Since ethical reasons do not permit to include placebo control groups in long-term trials it is not known presently how long the benefit from treatment lasts.
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PMID:[Effect pf anti-dementia drugs on the daily routine and attitude of dementia patients]. 1043 96

Antiepileptic drugs (AEDs) have various mechanisms of actions and therefore have diverse anticonvulsant, psychiatric, and adverse effect profiles. Two global categories of AEDs are identified on the basis of their predominant psychotropic profiles. One group has "sedating" effects in association with fatigue, cognitive slowing, and weight gain, as well as possible anxiolytic and antimanic effects. These actions may be related to a predominance of potentiation of gamma-aminobutyric acid (GABA) inhibitory neurotransmission induced by drugs such as barbiturates, benzodiazepines, valproate, gabapentin, tiagabine, and vigabatrin. The other group is associated with predominant attenuation of glutamate excitatory neurotransmission and has "activating" effects, with activation, weight loss, and possibly anxiogenic and antidepressant effects. This group includes agents such as felbamate and lamotrigine. Agents such as topiramate, with both GABAergic and antiglutamatergic actions, may have "mixed" profiles. Mechanisms of actions, activity in animal models of anxiety and depression, and clinical psychotropic effects of AEDs in psychiatric and epilepsy patients are reviewed in relationship to this proposed categorization. These considerations suggest the testable hypothesis that better psychiatric outcomes in seizure disorder patients could be achieved by treating patients with baseline "activated" profiles (insomnia, agitation, anxiety, racing thoughts, weight loss) with "sedating" predominantly GABAergic drugs, and conversely those with baseline "sedated" or anergic profiles (hypersomnia, fatigue, apathy, depression, sluggish cognition, weight gain) with "activating" predominantly antiglutamatergic agents. Systematic clinical investigation of more precise relationships of discrete mechanisms of actions to psychotropic profiles of AEDs is needed to assess the utility of this general proposition and define exceptions to this broad principle.
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PMID:Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. 1049 35

Evaluation of psychological well-being among persons with an advanced dementia is primarily dependent on verbal and non-verbal cues and behaviors that are observed and interpreted by others. The purpose of the present study was to determine how many components of psychological well-being can be measured. Fifty-seven individuals who were institutionalized for advanced dementia and exhibited agitation or withdrawal were evaluated by direct observations and by interviews with nursing home staff. Engagement was measured by the Lawton Positive Affect scale, visual analog scale, and reported degree of patient's interest in the environment. Mood was measured by a global indicator of mood interpreted from facial expression and two mood items from the Multidimensional Observation Scale for Elderly Subjects. Agitation was measured by a visual analog scale and by the Short Form of the Cohen-Mansfield Agitation Inventory. Correlation analyses and multidimensional scaling provided evidence for three dimensions of psychological well-being: engagement-apathy, happy sad mood, and calm-agitation. Evaluation of these three dimensions is important for measuring quality of care in long-term care settings and for determining effectiveness of therapeutic interventions.
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PMID:Dimensions of decreased psychological well-being in advanced dementia. 1060 67

Behavioral changes are common in Alzheimer disease (AD), and heterogeneous in their presentation. Subtle personality changes tend to occur early; these include apathy, irritability and inability to pay attention. Later agitation, aggression and disinhibited behaviors may appear. We have utilized the Columbia University Scale for Psychopathology in Alzheimer's Disease to monitor a number of behavioral symptoms in 235 patients with early probable AD. Markov analyses were used to predict the probability of developing or retaining a given symptom at 6-month follow-up. The results show that the symptoms of psychopathology in AD fluctuate with time. Agitation was both the most frequent and persistent symptom, while paranoid delusions and hallucinations were less persistent. Most behavioral disturbances, except paranoid delusions, were associated with greater cognitive impairment. There was no association between depressive features and either cognitive or functional impairment. These results have important implications for the optimal treatment of the psychopathological symptoms of AD.
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PMID:The interrelations between psychosis, behavioral disturbance, and depression in Alzheimer disease. 1062 73


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