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Pharmacotherapy of Alzheimer’s Disease (AD) and Behavioral and Psychological Symptoms of Dementia (BPSD) in Frail Older Patients

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NeuroPsychopharmacotherapy

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Abstract

With increasing mean population age worldwide, the prevalence of dementia – including Alzheimer’s disease (AD) – will rise. Many patients with AD and/or behavioral and psychological symptoms of dementia (BPSD) are also frail. Current drug therapy of AD and BPSD may consist of acetylcholinesterase inhibitors (AChEIs), antidepressants, anticonvulsants, and/or antipsychotics, especially if psychosocial interventions or other nonpharmacological interventions are not sufficient. Physicians often face challenges in the pharmacotherapy of frail patients with AD: Treatments may have a different risk-benefit calculus in this group, and robust guidelines are lacking due to an underrepresentation of frail older patients in clinical trials. Current evidence shows that acetylcholinesterase inhibitors seem to have small but significant positive effects on cognition and are generally well tolerated in frail patients with AD. In this patient group, antidepressants used to treat depressive symptoms appear to have only minor effects on neuropsychiatric or depressive symptoms, but are generally well tolerated. Antipsychotics and anticonvulsants for aggressive or psychotic symptoms in frail patients with AD appear to have small positive effects on neuropsychiatric symptoms, but also high rates of adverse events (AEs), which could lead to serious health consequences. In addition, as indicated in Beer’s criteria, many of these drugs are probably inappropriate for use in geriatric patients. This chapter reviews current evidence regarding efficacy and safety of pharmacotherapy of AD and BPSD in frail older patients, and provides clinical guidance on prescribing and deprescribing treatment.

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Author information

Authors and Affiliations

  1. Department of Neurology, University Clinic Ulm, Ulm, Germany

    M. Seibert & J. Holbrook

  2. Geriatric Center Ulm/Alb-Donau, Ulm, Germany

    M. Seibert

  3. Division of Geriatrics, University Medical Centre, Georg August University, Göttingen, Germany

    C. A. F. von Arnim

Authors
  1. M. Seibert
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  2. J. Holbrook
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  3. C. A. F. von Arnim
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Corresponding author

Correspondence to C. A. F. von Arnim .

Editor information

Editors and Affiliations

  1. Dept Psychiatry , Psychosomatics & Psychotherapy, University of Würzburg, Medical School Clinical Neurochemistry, Würzburg, Germany

    Peter Riederer

  2. Inst für Psychologische Medizin, Haag, Bayern, Germany

    Gerd Laux

  3. Fujita Health University School Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Bayern, Germany

    Christian Riederer

Section Editor information

  1. Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary

    István Bitter

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Seibert, M., Holbrook, J., von Arnim, C.A.F. (2022). Pharmacotherapy of Alzheimer’s Disease (AD) and Behavioral and Psychological Symptoms of Dementia (BPSD) in Frail Older Patients. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_428-1

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  • DOI: https://doi.org/10.1007/978-3-319-56015-1_428-1

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  • Print ISBN: 978-3-319-56015-1

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