Treatment Development for Neuropsychiatric Disturbances in Dementia: Past, Present, Future - Grand Rounds

Explore a comprehensive grand rounds presentation on the evolution of treatment approaches for neuropsychiatric disturbances in dementia. Delve into the historical context, current practices, and future directions of managing behavioral symptoms in dementia patients. Learn about the challenges faced in medication development, the limitations of existing diagnostic frameworks, and the potential of novel interventions. Examine the universal nature of neuropsychiatric symptoms in dementia and their fluctuating patterns. Gain insights into eco-psychosocial interventions and the complexities surrounding antipsychotic use. Discover emerging hypotheses based on etiology and the promising avenues for future treatment, including targeted approaches addressing the heterogeneity of neuropsychiatric symptoms. Understand the interplay between serotonin system loss and Alzheimer's disease, and how this knowledge is shaping new therapeutic strategies.

Intro
Learning objectives
Facing reality: balancing "cure" with "care"
Auguste D: hospitalized for delusions and change in personality, not cognitive impairment
NPS are UNIVERSAL (97%) & fluctuate Cache County Dementia Progression Study
Eco-psychosocial interventions behavioral, environmental, caregiver focused
Medication treatment development for NPS The past: BEFORE 2011
Medication Rxs disappointing when using existing DSM/ICD phenotypes
Antipsychotics: small benefit Antipsychotics carry "BLACK BOX" warning
Challenges of DSM-IV phenotypes
Overlap of symptoms Cache County Dementia Progression Study
Hypotheses based on etiology
The future: 2023 and beyond Novel medications for agitation
Serotonin system loss in AD early but not universal, interacts with ATN
Response limited to a subgroup HETEROGENEITY
Response depends on agitation phenotype Affective vs. Dysexecutive
Breaking down the heterogeneity of NPS The future: 2023 and beyond