Pharmacological treatment of neuropsychiatric symptoms

Behavioral and psychological symptoms of dementia cause premature institutionalization and significant loss of quality of life for the patient and his/her family and caregivers. An imbalance of different neurotransmitters (ACh, dopamine, noradrenaline, serotonin) has been proposed as the neurochemical correlate of these neuropsychiatric symptoms. The significant decrease in cholinergic activity may result in a relative increase in monoaminergic activities, leading to hypomanic or manic symptoms and behavior including delusions, hallucinations and physical aggression (Folstein, 1997). Conversely, AChE inhibitors have shown to be able to reduce neuropsychiatric severity (see Table 13.1).