Although cognitive disturbances such as memory and language impairment are the most recognized symptoms of dementia, the neuropsychiatric symptoms of dementia (NPSD) are often more concerning and can cause considerable disability and caregiver distress. The total annual cost of treatment for a patient with Alzheimer's disease (AD) who is living at home is estimated at $14,500. The direct management of behavioral and psychological symptoms accounts for 30% of this total. The last drug approval by the FDA for treatment of AD occurred approximately 15 years ago. Currently, no drug is FDA approved to treat NPSD, and no drugs for this indication are on the horizon. One second generation antipsychotic, risperidone, is approved in the United Kingdom and Australia for treating aggressive/assaultive behavior due to AD that poses harm to caregivers or the patient.
Nondrug approaches to managing NPSD, while recommended, are of questionable clinical value in reducing agitation or aggression in nursing home and assisted living facility residents with dementia. A variety of drugs are prescribed (off label) every day for behavioral symptoms related to dementia, despite the lack of FDA-approval. Many distinct types of drugs have been routinely used and/or studied to treat NPSD, including acetylcholinesterase inhibitors, antiepileptics, benzodiazepines, antipsychotics, antidepressants, and most recently, a combination of dextromethorphan and quinidine. None have emerged as clearly effective, resulting in many instances where a combination of medications is prescribed.
- Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, and Registered Nurses
This CE activity was developed by The Rx Consultant, a publication of Continuing Education Network, Inc.
CE activities for Pharmacists and Pharmacy Technicians:
This continuing education (CE) activity meets the requirements of all state boards of pharmacy for approved continuing education hours. CE credit is automatically reported to CPE Monitor.
CE activities for Nurse Practitioners and Clinical Nurse Specialists:
This continuing education activity meets the requirements of:
The American Nurses Credentialing Center (ANCC) for formally approved continuing education (CE) hours, and CE hours of pharmacotherapeutics.
The American Academy of Nurse Practitioners Certification Program (AANPCP) for acceptable, accredited CE.
This is a pharmacotherapeutics/pharmacology CE activity.
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Requirements for CE Credit
- Describe the neuropsychiatric symptoms of dementia and the factors that may lead to problem behaviors. Discuss how the type of dementia may lead to certain behavioral symptoms and impact treatment choice.
- Review the non-drug and drug therapy considerations for common behavioral and psychiatric symptoms of dementia. Describe the role of the combination pill containing dextromethorphan and quinidine
- Discuss the efficacy, side effects, and dosing for the most frequently used antipsychotics and antipressants for NPSD. List drug classes that have not been proven effective and/or have more risk than benefit for the management of NPSD.
Chris Stock, PharmD, BCPP
R. Ron Finley, BS Pharm, RPh, CGP
Brief Bio : R. Ron Finley, BS Pharm, RPh, CGP, Clinical Pharmacist, UCSF Memory and Aging Center, San Francisco, and Consultant Pharmacist, Brain Health Center, Sutter Health, Davies Campus, San Francisco, CA.
Tracy Farnen, PharmD
Brief Bio : Tracy Farnen, PharmD; Managing Editor, The Rx Consultant.