Abordaje de los síntomas psicológicos y comportamentales en demencia: serie de casos

Abstract

A brief review is made of the pharmacological approach to psychological and behavioural symptoms (SPCD) in dementia with the presentation of a series of cases in outpatient follow-up.

There are 6 cases, with a mean age of 87.3, five women and one man, with a diagnosis of dementia (multifactorial and Alzheimer's disease) who present to mental health for moderate apathy, ‘depressed mood’, restlessness and in four of them also poorly structured delusional ideation of harm. None of them had a history of psychotic disorder and only one of the patients had presented in her youth with an adaptive disorder that required antidepressant treatment.

The six cases had received treatment with antidepressants (SSRIs, either escitalopram or sertraline at low doses) as well as treatment with risperidone at a dose of 2.3mg as maintenance treatment of mood disorder symptoms, from Primary Care and Geriatrics in three of them. Those receiving antidepressant monotherapy maintained moderate apathy, as well as episodes of psychomotor restlessness. On the other hand, those receiving combined treatment with SSRIs and risperidone not only did not improve their affective symptoms, but also had extrapyramidal symptoms that affected them on a daily basis.

On examination, none of them showed first-rank depressive symptoms, but rather a flattening of the affective state in relation to moderate-severe cognitive impairment. In order to optimise treatment and to avoid inappropriate use of antipsychotics in these patients who are more susceptible to adverse effects, it was decided to start treatment with duloxetine, with a very progressive increase in dose and in two doses, until reaching doses of 90-120 mg as maintenance treatment of mood disorder symptoms.

After a month and a half of this treatment, the patients had significantly improved their apathy and restlessness, as well as reducing delusional ideation by improving their level of anxiety.

It is important to re-evaluate and adjust pharmacological treatment in elderly patients with dementia and SPCD. Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI), was shown to be effective in managing symptoms, especially apathy and restlessness, without the adverse effects associated with antipsychotics.