Neuropsychiatric Symptoms of Cognitive Impairment and Dementia

375 Pages·2017·5.85 MB·English

by  Ana Verdelho, Manuel Gonçalves-Pereira (eds.)

Neuropsychiatric Symptoms of Neurological Disease
Ana Verdelho
Manuel Gonçalves-Pereira Editors
Neuropsychiatric
Symptoms
of Cognitive
Impairment and
Dementia
Neuropsychiatric Symptoms of Neurological
Disease
Series editor
José M. Ferro
Department of Neurosciences and Mental Health, Stroke Unit. Centro Hospitalar
Lisboa Norte-Hospital de Santa Maria
Universidade de Lisboa
Lisboa , Portugal
Health care professionals are starting to realize the importance of managing
neuropsychiatric complications in neurological disease, they disturb the process of care
and are indicators of poor outcome, they also produce signifi cant caregiver burden.
This series will describe neuropsychiatric symptoms of major neurological diseases
including new drugs (new anti-psychotics, mood stabilizers, antidepressants,
cholinergic agents) that are available and other interventions for the management of
these complications.This series will be targeted at neurologists, geriatricians,
psychiatrists, internists, hospitalists, intensive care MDs, psychologists ad
neuropsychologists, research and specialised nurses, clinical researchers and
methodologists. Each volume will provide an up to date comprehensive review of the
neuropsychiatry of major neurological diseases by active authorities in the fi eld
internationally. Emphasis will be placed on the diagnostic and management issues to
serve as a tandard reference book for clinicians of several specialities.Volumes will
feature:- Critical appraisal of the methodological aspects and limitations of current
research including ongoing controversies in the fi eld.- Focus on the pharmacological
aspects of management to provide robust information on drug dosages, side effects and
interaction.
More information about this series at h ttp://www.springer.com/series/10501
Ana Verdelho (cid:129) Manuel Gonçalves-Pereira
Editors
Neuropsychiatric Symptoms
of Cognitive Impairment and
Dementia
Editors
Ana Verdelho Manuel Gonçalves-Pereira
Department of Neurosciences and Mental CEDOC, Chronic Diseases Research
Health, Centro Hospitalar Lisboa Center, Nova Medical School, Faculdade
Norte-Hospital de Santa Maria, Instituto de Ciências Médicas
de Medicina Molecular (IMM) and Universidade Nova de Lisboa
Instituto de Saúde Ambiental (ISAMB), Lisboa , Portugal
Faculdade de Medicina
Universidade de Lisboa
Lisboa , Portugal
ISSN 2196-2898 ISSN 2196-2901 (electronic)
Neuropsychiatric Symptoms of Neurological Disease
ISBN 978-3-319-39136-6 ISBN 978-3-319-39138-0 (eBook)
DOI 10.1007/978-3-319-39138-0
Library of Congress Control Number: 2016951490
© Springer International Publishing Switzerland 2017
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Foreword
Neuropsychiatric Symptoms of Cognitive Impairment and
Dementia
As is well advised from the Introduction, this book provides a holistic or biopsycho-
social update of the already “classic” concept, the Behavioral and Psychological
Symptoms of Dementia (BPSD), making clear that such symptoms not only appear
in dementia but in the course of many other neuropsychiatric conditions with cogni-
tive impairment.
T he clinicians that face everyday the challenge of direct contact with these
patients know that if anything characterizes these disorders, it is their c omplexity ,
which is the quality that one of the European fathers of geriatric psychiatry, Professor
Jean Wertheimer, identifi ed as the essence of psychogeriatrics.
I am always surprised how a problem of this type, described as serious, is some-
times easily and remarkably improved with a simple pharmacological intervention,
while in many other situations, it is only after several pharmacological approaches
and a “police” investigation with the patient, doctor, family, and professional care-
givers that we come to “understand” and eventually control it. In other words, these
disorders often require a mixture of diagnostic intervention (addressed to other hid-
den conditions), pharmacological intervention, interventions with professionals of
the nursing home, family interventions, etc.
W e are confi dent that reading a book of this nature can be a good “vaccine” to
prevent reductionist positions that oppose the biological bases of these disorders to
the psychosocial paradigm. I take this platform to confess that I am always surprised
by those phone calls of busy colleagues that in 2 minutes refer to me one of these
symptoms that are being suffered by their patient or relative and ask me to prescribe
the best drug at the exact dose (by the way, these phone calls may be quite diffi cult
if one aspires to maintain the courtesy due to another colleague but also clarify that
the best way of addressing these problems is through reading books like this one).
Clinical complexity requires interdisciplinary approaches, both to ensure accu-
rate diagnosis and to provide good treatment, and this is one of the virtues of the
v
vi Foreword
book: these problems are addressed in the light of the latest fi ndings in the neurobi-
ology of cognitive impairment, as well as describing a variety of psychotherapeutic
interventions, both individually and in group (family or professional team). Clinical
cases clearly illustrating this complexity are another virtue of the book.
S ome of these problems are devoted, for their importance, a specifi c chapter, as
it is the case of driving issues, the apathy syndrome, or the inappropriate sexual
behaviors, a topic much needed of scientifi c objectivity as well as of human
sensitivity.
T he clinical conditions where these issues manifest themselves are not limited to
dementia (either irreversible or reversible); on the contrary, they may accompany
other clinical pictures as in the case of progressive aphasia. And it’s very opportune
to include the classic syndrome of d elirium , frequently misdiagnosed as dementia:
treatment depends on early diagnosis.
The book also opens new horizons to approach these disorders: why not explore
the concept of “expressed emotions”, fruitfully used in schizophrenia relapse pre-
vention, in other chronic diseases such as dementia?
T he book ends with two fundamental chapters devoted to the family, reminding
us that informal caregivers are key-players in the therapeutic process, but that their
objectivity may be compromised as a result of their own suffering or previous rela-
tionship issues (probably unknown to the clinician).
I have found a very pleasant task to write this foreword for various reasons:
because the book is a comprehensive, holistic, interdisciplinary, and creative update,
because it is coherent with my clinical practice, and because I am involved with the
International Psychogeriatric Association (the book makes clear the seminal role of
IPA in this fi eld). I also appreciate an intergenerational balance of authors (clini-
cians, researchers, and academics), an additional merit of the editors.
W e are before a book that deserves a place not only in university libraries but also
in the offi ces of clinicians who everyday face such complex problems.
Professor of Psychiatry, University of Santiago Raimundo Mateos
de Compostela, Spain
President of the International Psychogeriatric
Association (IPA)
Pref ace
Neuropsychiatric Symptoms of Cognitive Impairment and Dementia is the fi fth of a
series of volumes on the neuropsychiatric aspects of common neurological diseases.
Previous volumes approached the neuropsychiatric symptoms of stroke and cere-
brovascular disease, movement disorders, multiple sclerosis, and epilepsy.
C ognitive impairment and dementia are among the most frequent causes of dis-
ability in elderly people. Due to world population aging, it is expected that the
number of persons suffering from cognitive impairment and dementia will continue
to rise in the future. Neuropsychiatric symptoms are very frequent in the context of
cognitive impairment, and this is particularly true of dementia. At least one neuro-
psychiatric symptom will affect almost everyone with dementia over the course of
their illness. These symptoms, also known as behavioral and psychological symp-
toms of dementia, interfere with well-being, are disruptive of social integration and
quality of life, and infl uence the type of care that is needed. In addition, they are
associated with a greater burden for caregivers (both informal and formal), often
determining institutionalization at some point over the course of the disease. Overall,
neuropsychiatric symptoms signifi cantly increase both the needs for care and the
direct and indirect costs associated with these conditions.
Several comprehensive and updated reviews of facets of this topic are available,
and they are acknowledged throughout the different chapters. The purpose of this
book is to revisit the subject, in an attempt to provide the reader with further practi-
cal insights and food for thought. Chapters are of different natures, but a substantial
proportion of the text mainly addresses clinical issues in practice. In attempting this,
we hope to reach not only neurologists and psychiatrists but a broader public that
also includes general practitioners, other specialist physicians, psychologists,
nurses, and all nonmedical professionals interested in cognitive impairment and
dementia. The fi rst section of the book relates to cognitive impairment in general,
focusing on a few specifi c aspects with great practical relevance: affective disorders
and mild cognitive deterioration, behavioral changes in primary progressive apha-
sia, the ability to drive in mild cognitive impairment, reduced initiative and apathy,
and neuropsychiatric symptoms in reversible dementias. The second section
addresses the main neuropsychiatric symptoms in dementia. It starts with the
vii
viii Preface
important differential diagnosis between d elirium and dementia, among other rea-
sons, because the former is often superimposed on the latter. This is followed by
depression and anxiety, agitation and aggressive behavior, psychotic syndromes,
inappropriate sexual behaviors, insomnia, and a particular focus on the spectrum of
neuropsychiatric symptoms in frontotemporal dementia. The fi nal section includes
perspectives on non-pharmacological approaches, which are still so neglected in
practice. Given that behavioral and psychological symptoms of dementia impact the
family, and family issues are crucial to understanding a part of those symptoms, the
discussion of this topic occupies a separate chapter. The book concludes with practi-
cal hints in the fi eld of family and informal caregiver interventions.
Of course there are subjects that are not fully covered, as the book does not aim
to be encyclopedic and bibliographies tend to be selective rather than exhaustive.
The different contributions seek to offer something of a refl ection of the authors’
clinical experience. We also acknowledge some overlaps between different chap-
ters. However, this mirrors what generally happens at least to some extent in routine
practice, and we rely on the clinically experienced reader’s indulgence in this
respect.
W e have not tried to impose a unique approach to classifi cation, in an area where
things have changed so much over the last few years and the debate is ongoing. The
reader will thus fi nd different options throughout the contributions. These include
using the WHO ICD-10 approach, DSM-V (which would leave the term “dementia”
out), the previous DSM-IV version, and clinical criteria outside these two main
classifi cations (as with “mild cognitive impairment”).
Finally, we would like to share with our readers how this adventure began, when
neurology invited psychiatry to jointly take responsibility for the production of this
book. We aimed at a balanced multi-professional approach to a topic that truly chal-
lenges clinicians’ ability to intervene and not least to work constructively as a team
in routine practice. This editorial collaboration mirrors several years of fruitful
clinical discussions between us, continuously learning from both success and fail-
ure. At the end of the day, editing this book was quite fun, and we sincerely hope the
reader will enjoy it as much as we did.
Lisbon, Portugal Ana Verdelho
Manuel Gonçalves-Pereira
Acknowledgments
We are most grateful to all the authors of the various chapters of this book for their
thoughtful and generous contributions and for being kind enough not to complain
about our own delays, faults, minor comments, and suggestions.
W e would also like to thank the editorial team for their support and patience
throughout this endeavor.
Our families should not be forgotten here, as we have been generously forgiven
for many extra hours of work.
F inally, we are deeply thankful to all our patients with neuropsychiatric symp-
toms of cognitive impairment or dementia and their families. We hope that every-
thing we have learned from them, including their strengths and resilience, can be
useful to others.
Lisbon, Portugal Ana Verdelho
Manuel Gonçalves-Pereira
ix