title: Pharmacological modulation of cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease.
abstract: To evaluate correlations of pharmacological treatment with cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease with low schooling, subjects were assessed for demographic features, neuropsychiatric symptoms, cognitive decline, functionality, caregiver burden, APOE haplotypes and pharmacological treatment. Among 217 patients, use of cholinesterase inhibitors with or without Memantine was associated with less neuropsychiatric symptoms, while anti-psychotics and/or anti-epileptic drugs were associated with lower instrumental functionality. Anti-psychotics were also associated with more neuropsychiatric symptoms in moderately impaired patients, possibly reflecting the greater need for such treatment when behavioral symptoms are present. Patients receiving more medications were usually younger, obese, married, with higher schooling and more neuropsychiatric symptoms. APOE4+ haplotypes were correlated with earlier dementia onset, but not with pharmacological treatment. Higher caregiver burden was associated with more psychotropic drugs. A trend was found for treatment with cholinesterase inhibitors and Memantine to be associated with longer lengths of dementia for moderately impaired but not for severely impaired patients, regardless of APOE haplotypes, translating into a synergistic effect among such medications for slowing cognitive decline but not for prolonging survival. Further longitudinal studies may be required to assess dose-response relationships regarding treatment with psychotropics for patients with dementia.
authors.affiliation: Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: fabricioferreiradeoliveira@hotmail.com.
authors.forename: Fabricio Ferreira
authors.initials: FF
authors.lastname: de Oliveira
authors.affiliation: Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: bertolucci.paulo@unifesp.br.
authors.forename: Paulo Henrique Ferreira
authors.initials: PH
authors.lastname: Bertolucci
authors.affiliation: Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: betty.morf@epm.br.
authors.forename: Elizabeth Suchi
authors.initials: ES
authors.lastname: Chen
authors.affiliation: Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: macsmith.morf@epm.br.
authors.forename: Marilia de Arruda Cardoso
authors.initials: Mde A
authors.lastname: Smith
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001526:Behavioral Symptoms / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008559:Memantine / Q000627:therapeutic use; D008875:Middle Aged; D009483:Neuropsychological Tests
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008559:Memantine
keywords: Alzheimer disease; Cognitive disorders; Dementia; Drug therapy; Neurodegenerative diseases; Neuropsychiatry