Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions

Jeremy Koppel,1,2 Blaine S Greenwald2 1The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY, USA; 2Zucker Hillside Hospital, Hofstra North Shore-Long Island Jewish School of Medicine, Glen Oaks, NY, USA Abstract: Psychotic symptoms em...

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Autores principales:	Koppel J, Greenwald BS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/3d479cac9fa34f3b840d95db69aebe64
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spelling	oai:doaj.org-article:3d479cac9fa34f3b840d95db69aebe642021-12-02T06:32:58ZOptimal treatment of Alzheimer’s disease psychosis: challenges and solutions1178-2021https://doaj.org/article/3d479cac9fa34f3b840d95db69aebe642014-11-01T00:00:00Zhttp://www.dovepress.com/optimal-treatment-of-alzheimerrsquos-disease-psychosis-challenges-and--peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021 Jeremy Koppel,1,2 Blaine S Greenwald2 1The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY, USA; 2Zucker Hillside Hospital, Hofstra North Shore-Long Island Jewish School of Medicine, Glen Oaks, NY, USA Abstract: Psychotic symptoms emerging in the context of neurodegeneration as a consequence of Alzheimer’s disease was recognized and documented by Alois Alzheimer himself in his description of the first reported case of the disease. Over a quarter of a century ago, in the context of attempting to develop prognostic markers of disease progression, psychosis was identified as an independent predictor of a more-rapid cognitive decline. This finding has been subsequently well replicated, rendering psychotic symptoms an important area of exploration in clinical history taking – above and beyond treatment necessity – as their presence has prognostic significance. Further, there is now a rapidly accreting body of research that suggests that psychosis in Alzheimer’s disease (AD+P) is a heritable disease subtype that enjoys neuropathological specificity and localization. There is now hope that the elucidation of the neurobiology of the syndrome will pave the way to translational research eventuating in new treatments. To date, however, the primary treatments employed in alleviating the suffering caused by AD+P are the atypical antipsychotics. These agents are approved by the US Food and Drug Administration for the treatment of schizophrenia, but they have only marginal efficacy in treating AD+P and are associated with troubling levels of morbidity and mortality. For clinical approaches to AD+P to be optimized, this syndrome must be disentangled from other primary psychotic disorders, and recent scientific advances must be translated into disease-specific therapeutic interventions. Here we provide a review of atypical antipsychotic efficacy in AD+P, followed by an overview of critical neurobiological observations that point towards a frontal, tau-mediated model of disease, and we suggest a new preclinical animal model for future translational research. Keywords: Alzheimer’s disease, antipsychotics, psychosis, tau, behavioral disturbance, agitation Koppel JGreenwald BSDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2014, Iss default, Pp 2253-2262 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Koppel J Greenwald BS Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions
description	Jeremy Koppel,1,2 Blaine S Greenwald2 1The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY, USA; 2Zucker Hillside Hospital, Hofstra North Shore-Long Island Jewish School of Medicine, Glen Oaks, NY, USA Abstract: Psychotic symptoms emerging in the context of neurodegeneration as a consequence of Alzheimer’s disease was recognized and documented by Alois Alzheimer himself in his description of the first reported case of the disease. Over a quarter of a century ago, in the context of attempting to develop prognostic markers of disease progression, psychosis was identified as an independent predictor of a more-rapid cognitive decline. This finding has been subsequently well replicated, rendering psychotic symptoms an important area of exploration in clinical history taking – above and beyond treatment necessity – as their presence has prognostic significance. Further, there is now a rapidly accreting body of research that suggests that psychosis in Alzheimer’s disease (AD+P) is a heritable disease subtype that enjoys neuropathological specificity and localization. There is now hope that the elucidation of the neurobiology of the syndrome will pave the way to translational research eventuating in new treatments. To date, however, the primary treatments employed in alleviating the suffering caused by AD+P are the atypical antipsychotics. These agents are approved by the US Food and Drug Administration for the treatment of schizophrenia, but they have only marginal efficacy in treating AD+P and are associated with troubling levels of morbidity and mortality. For clinical approaches to AD+P to be optimized, this syndrome must be disentangled from other primary psychotic disorders, and recent scientific advances must be translated into disease-specific therapeutic interventions. Here we provide a review of atypical antipsychotic efficacy in AD+P, followed by an overview of critical neurobiological observations that point towards a frontal, tau-mediated model of disease, and we suggest a new preclinical animal model for future translational research. Keywords: Alzheimer’s disease, antipsychotics, psychosis, tau, behavioral disturbance, agitation
format	article
author	Koppel J Greenwald BS
author_facet	Koppel J Greenwald BS
author_sort	Koppel J
title	Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions
title_short	Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions
title_full	Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions
title_fullStr	Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions
title_full_unstemmed	Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions
title_sort	optimal treatment of alzheimer’s disease psychosis: challenges and solutions
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/3d479cac9fa34f3b840d95db69aebe64
work_keys_str_mv	AT koppelj optimaltreatmentofalzheimerrsquosdiseasepsychosischallengesandsolutions AT greenwaldbs optimaltreatmentofalzheimerrsquosdiseasepsychosischallengesandsolutions
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Optimal treatment of Alzheimer&rsquo;s disease psychosis: challenges and solutions

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Optimal treatment of Alzheimer’s disease psychosis: challenges and solutions