By: Dr. Soheil Souri, MD

Published: January 10, 2017

The term dementia or cognitive impairment is used to denote a progressive neurological disorder. It has many variations and types, among which Alzheimer’s disease is considered the most widespread one. While mental disorders present some common symptoms and may result in similar outcomes, the way in which each disorder develops is different, starting from brain dysfunction and leading to other conditions, thus requiring caregivers to approach each case individually. An in-depth dementia evaluation can narrow the diagnosing and treatment options down, and at the same time, provide an opportunity for individuals and their families to expand the knowledge about the disease. It involves blood tests, brain scan, cognitive testing, and clinical history analysis. The clinicians’ task is to conduct the above-mentioned examination properly in order to make the most accurate conclusion. Timely identification of the disease and its main symptoms helps to prescribe the most effective treatment and avoid further complications. In this regard, it is essential to pay attention to neuropsychiatric symptoms associated with dementia among other features of this disorder.

There are number of symptoms that may challenge patients’ daily life, such as wandering, resistance to daily support, aggression, sleeping problems, disruptive vocalizations, sexually deviant behavior, and other social withdrawals, which can even make a person dangerous to society. Other essential symptoms associated with dementia include limited executive functions, visual and spatial deficits, problems with emotional stability, and disability to choose and effectively apply coping strategies (Niedens, 2012). It should be mentioned that eating and sleeping problems are also peculiar for other diseases, thus causing confusion in the process of diagnosing dementia. Resistance to care can become a major challenge for the treatment procedures, because people with the discussed disorder often expose aggressive attitude and the lack of trust to other people. As a result, there is a real obstacle for clinicians, who strive to provide effective moral and professional support to such patients. Finally, the symptoms might involve fear, depression, fatigue, pain, communication barriers, psychosis, and modesty. All of the issues equally hamper the process of recovery and management of cognitive instability, so caregivers should the possibility of such a risk. In this regard, there should always be precautionary measures in order to provide the most effective treatment possible.

Neuropsychiatric symptoms occur in the course of dementia development, particularly in case of Alzheimer’s disease. They also take place with higher frequency in the dementia prodrome of cognitive impairment. The symptoms can point to dementia prodrome as the mild form of impairment and behavioral deviation. They also relate to a range of negative outcomes, such as accelerated transitions and faster progression from mild to severe forms of cognitive dissonance. The diverse nature and context of neuropsychiatric symptoms can complicate the treatment process (Niedens, 2012). They are heterogeneous in terms of causes and phenomenology. A variety of signs and symptoms has been distinguished, but they are likely to aggregate into expected groups, particularly in milder forms (Lyketsos, 2015). Hence, the recent treatment option target proposed and presumptive symptoms. From this perspective, it is possible to differentiate neuropsychiatric symptoms according to several factors they stem from. They include the brain neurodegenerative process due to disruption of brain functions related to behavior, motivation, affect, and perception, which causes disorder emergence either by direct harm to brain circuits, or by developing the vulnerable areas predetermined by the environmental influence. Furthermore, NPS can occur due to complexities that individuals encounter while adapting to the surrounding when they lose cognitive abilities.

The treatment development has to cover a range of issues simultaneously and embrace a holistic approach. Borsje, Wetzels, Lucassen, Pot, and Koopmans (2014) support the idea that neuropsychiatric symptoms, including psychosis, depressive mood, apathy, euphoria, irritability, aggression, as well as eating and sleeping disorders, are also typical for people with cognitive disability. What is more, the symptoms can be predetermined by lower quality of life conditions, as well as insufficient support on the part of the caregiver. Major depression can result from some psychological, moral, and social factors that cause the symptoms and define the new approach to management and reporting.

Due to the variety of treatment options for neuropsychiatric symptoms, the challenges and issues related to therapeutic process are also diverse. Mulsant (2014) explains that clinicians tend to use non-pharmacological interventions, which is a recommended option before introducing drugs to the treatment procedures. However, the use of medication is required in the majority of cases, requiring additional measures and implying some legal standards and procedures. Hence, it is essential for clinicians to receive the written consent from the third party before introducing support. It is necessary to point out that the use of antidepressant may become a challenge because it does not provide the long-term effect. Furthermore, it can harm in the case of improper doze is proposed. Therefore, the combination of therapeutic activities and medications could introduce new approaches. Finally, it has been reported that the increase in mortality rates relates to antipsychotics use. During the first days of application, the risk ratio for the use of psychotropic substances versus antipsychotics corresponds with the doubles rates of threat for patients.

Considering the above presented concerns, as well as diversity of symptoms and the nature of the disease, there is a necessity to introduce a range of effective measures to enable healthcare professionals to choose proper treatment options and disease management approaches. In this respect, Nowrangin, Lyketsos, and Rosenberg (2015) underline that treatment strategies for mood syndromes, such as apathy and depression, are specifically associated with serotonergic mechanisms with dopaminergic or antidepressants schemes with psychostimulants. Psychotic symptoms are being treated with anti-psychotic medications regardless the controversies of risk/benefit ratios. The control and monitoring of behavioral deviation, including aggression and agitation, embraced a variety of psychoactive medications along with the non-pharmacological methods. Finally, it is highly essential to suggest rational therapeutic approach to deal with neuropsychiatric symptoms, which require a deeper understanding of the highlighted etiology to advance the nosology, and offer the new evidence-based strategy, which is vital for surpassing the funding and regulatory challenges. Such framework can promote the research study that focuses on debilitating symptoms. It can also expand psychological, moral, and cognitive peculiarities that highlight some of the individualized approaches for treatment and management of the disease. Regular meetings should be also included.

In conclusion, the neuropsychiatric symptoms include depression, anxiety, fear, repetitive questions, and reluctance to accept care associated with the mild cognitive impairment. In is essential to mention that the nature of neuropsychiatric symptoms is heterogeneous, which complicates the clinicians’ decisions in terms of diagnosing and treatment. However, when these symptoms are associated with dementia, particularly with Alzheimer’s disease, the attention should be given to the combined treatment options that entail both therapeutic and pharmacological approaches. Additionally, clinicians should not underestimate the importance of legal regulations that require receiving consent from family members for further options. They should also study historical records and genetic problems to understand the root of the problem and establish the diagnosis in the most effective way. The review of the recent research has also reported some of the additional symptoms and etiology depending on the severity of the disorder and individuals’ unique psychological and social environment.