Marwan Sabag, M.D.: These questions apply to Dr. Atli about neuropsychiatric symptoms. This is a major contributor to morbidity and mortality, especially as the disease progresses. We can articulate what we want to achieve, but as they progress we are dealing with different things in the mild stages and in the neuropsychiatric features of the moderate than in the neuropsychiatric features. Could you please comment on the traditional medicines we use to treat AD? Also please comment on the new drugs under investigation and some of the new drugs reported here at CTAD. [Clinical Trials on Alzheimer’s Disease conference].
Alireza Atli, MD, PhD: yes. I agree with you. I am a cognitive neurologist, and if neuropsychiatric symptoms and behavior are controlled, it can support cognition and function. It affects quality of life and function and their care. Behavior is paramount and affects quality of life. Insert the plugin into the Harvard Medical School Dementia course. I’ll say something in two minutes. But ultimately, the first part is recognition. Is education also apathy, lack of motivation, and often misdiagnosed as depression early on? It is not uncommon for patients to come to us. Hmm. [selective serotonin reuptake inhibitor]It is different from true depression, irritability, or anxiety. These are possible, may require treatment, and are different from agitation, aggression, and frank psychosis. they are all different.
But the first step is its knowledge, awareness and accurate diagnosis. Then examine the trigger. What are the triggers? Numbers 1, 2, 3, 4, 5 are always detective and dehydrated?do they have a UTI [urinary tract infection]Are you saying they don’t sleep well? Does that mean no one is talking to them? Do you have joint pain or arthritis that people are unaware of? Many of them can be environment related and you can adapt to it. But when it gets serious, for example, when there is aggression, agitation, or psychosis that ends up being very serious and immediately harms someone’s safety, including the patient, our equipment is limited. The need is so great that nothing has been approved in the United States. Clinicians are reaching for things.
I don’t think one canonical part of this is to minimize the effects of background therapy. So, there’s been data over the years that suggests you get a little feverish. It’s not like, “It will appear.” But it’s something in the background that people shouldn’t take lightly. There is a black box caveat because the off-label ones that people sometimes use are antipsychotics and are associated with increased morbidity and mortality, including extrapyramidal symptoms, sedation and falls. pull the trigger. It must be done carefully. Although individuals may use SSRIs, there is some data from studies of citalopram.
I’ll put in a plug-in for escitalopram under study, but it’s so widely used because of black box warnings that it can make patient recruitment difficult. But what are you giving up there? We may abandon cognition and affect the QT interval. There is some new data presented here for something like brexpiprazole. No, but it has shown promise in terms of safety as well as efficacy. There are several forms and others have been added to increase availability.
Edited transcript for clarity