Section - Quick Takes

04. Managing Psychosis, Agitation, and Depression in Patients with Dementia

Published on August 1, 2024 Certification expiration date: August 1, 2027

Scott R. Beach, M.D.

Associate Professor of Psychiatry - Harvard Medical School - Massachusetts General Hospital

Key Points

Neuropsychiatric syndromes are common in neurodegenerative diseases, associated with rapid decline and caregiver burden, but management remains challenging with limited evidence-based options.
Psychosis presentations vary by neurodegenerative disease; antipsychotic evidence is mixed, with some support for clozapine, aripiprazole, and risperidone, but not quetiapine or olanzapine.
Agitation and depression treatments in neurodegenerative diseases lack robust evidence; apathy may respond to stimulants in Alzheimer's, while disinhibition has no approved treatments.

To unlock this audio you need to become a Silver, Gold, Silver extended or Gold extended Member.

Check Our CME Program

Downloads for Offline Access

Download Audio File (MP3)

Text version

Managing Neuropsychiatric Syndromes in Neurodegenerative Diseases

If you see older patients in your clinic or if you work in emergency or inpatient settings, undoubtedly one of your biggest challenges is managing neuropsychiatric syndromes in patients with neurodegenerative diseases or NDDs.

These syndromes are exceedingly common. In Alzheimer’s disease, for example, almost all patients will eventually manifest at least one neuropsychiatric syndrome.

Such syndromes are associated with more rapid decline, poor quality of life and greater caregiver burden. Despite their prevalence, these phenomena are not as well studied as we might like.

Management remains very challenging, with few medications approved specifically for these indications and little data from placebo-controlled trials to guide us. In this setting, a recent review in JAMA Neurology attempts to summarize potential strategies for managing some of these common neuropsychiatric symptoms in NDDs.

Psychosis: Types of Delusions and Management Strategies

When discussing psychosis, the authors do a

Unlock this Quick Take and earn 0.75 CMEs
Become a Silver, Gold, Silver extended or Gold extended Member.

Get Instant Access

Already have an account? Sign in

Table of Contents

Next Section

05. Geriatric Depression: Ranking Antidepressant Efficacy, Tolerability, and Outcomes

Learning Objectives:

After completing this activity, the learner will be able to:

Evaluate the risks and benefits of co-prescribing SSRIs and oral anticoagulants, particularly in the first month of combined use.
Describe patterns of long-term benzodiazepine use and dose escalation in adult patients, including risk factors for dose escalation.
Assess the impact of antidepressant medication on cognitive symptoms in late-life depression, particularly in the domains of memory and learning.
Compare and contrast management strategies for common neuropsychiatric syndromes in neurodegenerative diseases, including psychosis, agitation, and depression.
Analyze the efficacy, tolerability, and outcomes of different antidepressants in geriatric patients with depression based on real-world data.

Original Release Date: August 1, 2024

Expiration Date: August 1, 2027

Experts: Scott Beach, M.D., Paul Zarkowski, M.D.

Medical Editor: Flavio Guzmán, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.