Management of neuropsychiatric symptoms in people with neurocognitive disorder - using add-on antidepressants or NMDA antagonists in relieving agitation

Background. Alzheimer’s disease (AD) is by far the most common type of dementia and it is commonly considered as a memory disorder although behavioral and psychological (including psychiatric) symptoms (BPSD) are largely represented in these patients. Psychosis could explain the worsening of the functional prognosis in these patients, therefore antipsychotic drugs are comonly prescribed. The risks associated with antipsychotics use limit their recommendation and antidepresants or NDMA (N-methyl-d-aspartate) antagonists could represent an alternative. Aims. The aim of this study was to evaluate changes in the clinical status of the psychomotor agitated patients with neurocognitive disorder on stable antidementia therapy after the addition of antidepressants or NMDA antagonists. Methods. The primary variables of this study are related to the severity of agitation under the action of pharmacological factors. Agitation as part of the BPSD was evaluated by CMAI (Cohen-Mansfield Agitation Inventory)-short version. A total of 37 subjects (24 female, 14 male) participated in this observational study. They received as add-on antidepressants between weeks 1-8 or NMDA antagonists between weeks 8-16. Inclusion criteria were DSM IV-TR criteria for diagnosing dementia, AD and vascular dementia (VD) and also NINDS-ADRDA clinical criteria. Data analysis was achieved through SPSS software, version 20, using ANOVA- paired t-tests and independent t tests. Results. The efficacy of memantine over general agitation was significantly superior to antidepressants. Regarding the modulation of the CMAI scores evolution by the type of neurocognitive disorder, treatment and duration, it was observed that the statistical difference between groups became significant after 8-16 weeks of memantine treatment. At the endpoint visit the decrease in agitation was superior in the AD versus VD group (p = 0.012). Conclusions. The overall trend was toward a decrease of the agitation severity after each treatment trial for both types of dementia, including cumulative drugs effects. In the literature, the data are controversial in terms of prescribing antidepressants in the neurocognitive disorders even when BPSD is important, the keystone being the general consensus of limiting the use of antipsychotics and polypharmacy.