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.
This issue will review medications commonly prescribed for the management of dementia-associated neuropsychiatric symptoms, and discuss the pros andcons of selected agents. It is intended to serve as a guide to the safe, appropriate use of medications to manage troublesome behaviors related to AD, vascular dementia, dementia of the Lewy body type, and frontotemporal lobe dementia – the most prevalent types of dementia in the US and Europe.
Fee
CE Hours
CE Units
Activity Type
- Knowledge-based
Target Audience(s)
- This accredited program is targeted to pharmacy technicians.
Accreditation(s)
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.
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.
- The ANCC requires all advanced practice nursing certificants (CNSs and NPs) to complete 25 CE hours of pharmacotherapeutics as a portion of the required 75 continuing education hours.
- Pharmacology CE is recommended by the AANPCP and will be required for Certificants renewing certification starting January 2017.
- Most State Boards of Nursing require a minimum number of pharmacy contact hours to renew an advanced practice license.
Requirements for CE Credit
Objectives
- Describe NPSD and the accompanying symptoms; understand factors that can contribute to the development of these symptoms. List the 4 most prevalent types of dementia.
- List the primary classes of medications used for treatment of NPSD. Provide 2 examples of each and list their brand and generic names.
- Provide the usual dosing information and common side effects for antipsychotics, antidepressants, and insomnia medications commonly used off-label for NPSD.
Activity Number
0428-0000-16-007-H01-T