Abstract
Background: Alzheimer's disease (AD) is characterized by neuropsychiatric symptoms (NPS), which cause great misery to those with dementia and those who care for them and may lead to early institutionalization.
Objective: The present systematic review aims to discuss the various aspects of Alzheimer’s, including treatment options.
Methods: The databases Embase, PubMed, and Web of Science were searched to collect data.
Results: Incipient cognitive deterioration is commonly accompanied by these early warning signals of neurocognitive diseases. The neurobiology of NPSs in Alzheimer's disease, as well as particular symptoms, including psychosis, agitation, apathy, sadness, and sleep disorders, will be examined in this review. For NPSs in Alzheimer's disease, clinical trial designs, as well as regulatory issues, were also addressed. A fresh wave of research, however, is helping to push the discipline ahead. For medication development and repurposing, we highlight the most recent results in genetics, neuroimaging, and neurobiology. Even though identifying and treating psychosis in adults with dementia is still a challenging endeavor, new options are coming up that give the field fresh focus and hope.
Conclsuion: It can be concluded from the complete literature survey that Alzheimer's-related psychosis as well as other symptoms that are not psychotic, have made significant progress in the last decade. These milestones in the development of safer, more effective treatments have been achieved as a consequence of great focus on non-pharmacological interventions like DICE or WHELD; the investigation into ways to improve existing drugs like aripiprazole, risperidone, amisulpride, and Escitalopram for safer precision-based treatment; and the development of a clinical trial program for pimavanserin.
Graphical Abstract
[http://dx.doi.org/10.1002/gps.1858] [PMID: 17607801]
[http://dx.doi.org/10.1016/j.trci.2017.07.001] [PMID: 29067350]
[http://dx.doi.org/10.1016/j.jalz.2011.05.2410] [PMID: 21889116]
[http://dx.doi.org/10.1080/14737175.2018.1476140] [PMID: 29764230]
[http://dx.doi.org/10.1038/nrneurol.2009.39] [PMID: 19488082]
[http://dx.doi.org/10.1186/s12877-020-01607-7] [PMID: 32546202]
[http://dx.doi.org/10.1111/j.1532-5415.1998.tb02542.x] [PMID: 9475452]
[http://dx.doi.org/10.1002/gps.437] [PMID: 11571766]
[http://dx.doi.org/10.1159/000339954] [PMID: 22814093]
[http://dx.doi.org/10.1159/000090251] [PMID: 16352909]
[http://dx.doi.org/10.1001/archneur.62.10.1601] [PMID: 16216946]
[http://dx.doi.org/10.1016/j.jagp.2013.03.014] [PMID: 23871118]
[http://dx.doi.org/10.1176/appi.ajp.162.11.2022] [PMID: 16263838]
[http://dx.doi.org/10.1002/(SICI)1099-1166(200002)15:2<99:AID-GPS82>3.0.CO;2-5] [PMID: 10679840]
[http://dx.doi.org/10.2174/1567205014666170829114346] [PMID: 28847281]
[http://dx.doi.org/10.1007/s11920-011-0195-1] [PMID: 21404128]
[PMID: 30298184]
[http://dx.doi.org/10.1002/gps.4933] [PMID: 29979473]
[http://dx.doi.org/10.1192/bjp.2019.195] [PMID: 31506117]
[http://dx.doi.org/10.1016/j.trci.2017.06.001] [PMID: 29067344]
[http://dx.doi.org/10.3233/JAD-150606] [PMID: 26682680]
[http://dx.doi.org/10.1177/089198878800100104] [PMID: 3266997]
[http://dx.doi.org/10.1016/j.biopsych.2013.08.020] [PMID: 24103379]
[http://dx.doi.org/10.1159/000506510] [PMID: 32308668]
[http://dx.doi.org/10.1007/s11910-019-0972-5] [PMID: 31250123]
[http://dx.doi.org/10.1016/j.cortex.2016.07.014] [PMID: 27542857]
[http://dx.doi.org/10.1016/j.neubiorev.2017.02.021] [PMID: 28235545]
[http://dx.doi.org/10.1002/gps.930100904]
[http://dx.doi.org/10.1097/00019442-200002000-00004] [PMID: 10648292]
[http://dx.doi.org/10.1097/WAD.0b013e3181f811f4] [PMID: 20921878]
[http://dx.doi.org/10.1016/j.jagp.2012.10.013] [PMID: 23290205]
[http://dx.doi.org/10.3233/JAD-2009-1120] [PMID: 19542627]
[http://dx.doi.org/10.1016/j.jagp.2020.09.002] [PMID: 32958332]
[http://dx.doi.org/10.1097/00019442-200307000-00004] [PMID: 12837670]
[http://dx.doi.org/10.1017/S1041610214001963] [PMID: 25311499]
[http://dx.doi.org/10.1002/alz.12335] [PMID: 34132461]
[http://dx.doi.org/10.1159/000110738] [PMID: 17986816]
[http://dx.doi.org/10.1017/S1041610217001879] [PMID: 28927477]
[http://dx.doi.org/10.1016/j.jamda.2019.02.012] [PMID: 30926409]
[http://dx.doi.org/10.1159/000507078] [PMID: 32289790]
[http://dx.doi.org/10.1016/j.jagp.2013.01.049] [PMID: 23567370]
[http://dx.doi.org/10.1111/psyg.12447] [PMID: 30891900]
[http://dx.doi.org/10.3233/JAD-190025] [PMID: 31127783]
[http://dx.doi.org/10.1016/j.jagp.2013.01.006] [PMID: 23567400]
[http://dx.doi.org/10.1212/WNL.0000000000001307] [PMID: 25653291]
[http://dx.doi.org/10.1017/S1041610217000874] [PMID: 28560931]
[http://dx.doi.org/10.1017/S1041610219001352] [PMID: 32295673]
[http://dx.doi.org/10.1017/S1041610219000966] [PMID: 31354123]
[http://dx.doi.org/10.1192/bjp.183.3.213] [PMID: 12948993]
[http://dx.doi.org/10.1016/j.jagp.2012.10.010] [PMID: 23343485]
[http://dx.doi.org/10.1371/journal.pone.0178471] [PMID: 28622335]
[http://dx.doi.org/10.1186/s13195-020-00604-7] [PMID: 32234066]
[http://dx.doi.org/10.1002/gps.2075] [PMID: 18561206]
[http://dx.doi.org/10.1111/j.1447-0594.2009.00505.x] [PMID: 19260981]
[http://dx.doi.org/10.1017/S003329171800065X] [PMID: 29564993]
[http://dx.doi.org/10.1017/S0033291721002099] [PMID: 34030750]
[http://dx.doi.org/10.1007/s00406-013-0472-6] [PMID: 24272318]
[http://dx.doi.org/10.3233/JAD-190828] [PMID: 31884469]
[http://dx.doi.org/10.1097/00019442-200507000-00011] [PMID: 16009739]
[http://dx.doi.org/10.1038/s41380-021-01152-8] [PMID: 34112972]
[http://dx.doi.org/10.1002/ajmg.b.32413] [PMID: 26756273]
[PMID: 28219318]
[http://dx.doi.org/10.1038/mp.2017.81] [PMID: 28461698]
[http://dx.doi.org/10.1038/s41398-019-0592-5] [PMID: 31641104]
[http://dx.doi.org/10.1001/jamapsychiatry.2019.2508] [PMID: 31553412]
[http://dx.doi.org/10.1016/j.biopsych.2019.12.010] [PMID: 32087949]
[http://dx.doi.org/10.1002/ajmg.b.32630] [PMID: 29603866]
[http://dx.doi.org/10.1093/schbul/sbw191] [PMID: 28399309]
[http://dx.doi.org/10.1073/pnas.1419064111] [PMID: 25422463]
[http://dx.doi.org/10.1038/nn.3782] [PMID: 25129077]
[http://dx.doi.org/10.1016/j.jalz.2018.01.017] [PMID: 29550519]
[PMID: 28011714]
[http://dx.doi.org/10.1016/j.neurobiolaging.2020.01.001] [PMID: 32007278]
[http://dx.doi.org/10.1002/ajmg.b.32549] [PMID: 28548708]
[http://dx.doi.org/10.1001/jamaneurol.2016.1593] [PMID: 27723861]
[http://dx.doi.org/10.1016/j.pscychresns.2012.01.008] [PMID: 22703622]
[http://dx.doi.org/10.1016/j.jagp.2018.09.016] [PMID: 30503703]
[http://dx.doi.org/10.1111/psyg.12369] [PMID: 30430708]
[http://dx.doi.org/10.1002/gps.4757] [PMID: 28741694]
[http://dx.doi.org/10.1192/bjp.165.1.53] [PMID: 7953058]
[http://dx.doi.org/10.1016/j.jagp.2013.03.006] [PMID: 23890751]
[http://dx.doi.org/10.1002/gps.4291] [PMID: 25821062]
[http://dx.doi.org/10.1002/hbm.22248] [PMID: 23418130]
[http://dx.doi.org/10.30773/pi.2020.0009] [PMID: 32571002]
[http://dx.doi.org/10.1016/j.jagp.2019.03.020] [PMID: 31130416]
[http://dx.doi.org/10.1186/s12883-017-0911-5] [PMID: 28754095]
[http://dx.doi.org/10.1371/journal.pone.0114774] [PMID: 25479196]
[http://dx.doi.org/10.1016/j.jagp.2013.06.005] [PMID: 24021220]
[http://dx.doi.org/10.1017/S1041610213000094] [PMID: 23433495]
[http://dx.doi.org/10.1016/j.pscychresns.2009.03.007] [PMID: 19682865]
[http://dx.doi.org/10.1212/01.wnl.0000341932.21961.f3] [PMID: 19204262]
[http://dx.doi.org/10.1016/j.neurobiolaging.2014.03.003] [PMID: 24731519]
[http://dx.doi.org/10.3233/JAD-131166] [PMID: 24270207]
[http://dx.doi.org/10.3233/JAD-180688] [PMID: 30223398]
[http://dx.doi.org/10.1176/appi.ajp.2018.17080858] [PMID: 30021459]
[http://dx.doi.org/10.1017/S1041610211000974] [PMID: 21740613]
[http://dx.doi.org/10.1176/appi.ajp.2013.13040466] [PMID: 24084821]
[http://dx.doi.org/10.1093/brain/awz238] [PMID: 31504227]
[http://dx.doi.org/10.1016/j.neurobiolaging.2012.02.015] [PMID: 22429885]
[http://dx.doi.org/10.1002/gps.4908] [PMID: 29856089]
[http://dx.doi.org/10.1016/j.neurobiolaging.2014.06.015] [PMID: 25104558]
[http://dx.doi.org/10.1177/0891988706292755] [PMID: 17085757]
[http://dx.doi.org/10.1038/srep20858] [PMID: 26868671]
[http://dx.doi.org/10.1136/jnnp-2018-318445] [PMID: 30054314]
[http://dx.doi.org/10.3233/JAD-160506] [PMID: 27662301]
[http://dx.doi.org/10.1002/gps.3980] [PMID: 23681754]
[http://dx.doi.org/10.5604/1232-1966.1108615] [PMID: 24959800]
[http://dx.doi.org/10.12779/dnd.2017.16.3.78] [PMID: 30906375]
[http://dx.doi.org/10.1001/archneur.58.3.466] [PMID: 11255451]
[http://dx.doi.org/10.1093/brain/aww359] [PMID: 28334978]
[http://dx.doi.org/10.1038/s41598-020-63021-8] [PMID: 32273551]
[http://dx.doi.org/10.1016/S1474-4422(18)30039-5] [PMID: 29452684]
[http://dx.doi.org/10.1186/s13195-019-0519-7] [PMID: 31511061]
[http://dx.doi.org/10.7326/M19-0993] [PMID: 31610547]
[http://dx.doi.org/10.1111/jgs.12730] [PMID: 24635665]
[http://dx.doi.org/10.1007/s11920-018-0978-8] [PMID: 30367272]
[http://dx.doi.org/10.1177/0269881117744996] [PMID: 29338602]
[http://dx.doi.org/10.1111/ggi.12126] [PMID: 23910097]
[http://dx.doi.org/10.1001/jama.2012.36918] [PMID: 23168825]
[http://dx.doi.org/10.1097/01.JGP.0000200589.01396.6d] [PMID: 16505124]
[http://dx.doi.org/10.1177/2040622316658463] [PMID: 27583123]
[http://dx.doi.org/10.1517/14740338.2010.506711] [PMID: 20684745]
[http://dx.doi.org/10.1001/jamapsychiatry.2014.3018] [PMID: 25786075]
[http://dx.doi.org/10.1001/jama.2011.1360] [PMID: 21954480]
[http://dx.doi.org/10.1038/nrn1926] [PMID: 16715057]
[http://dx.doi.org/10.1001/jamanetworkopen.2019.0828] [PMID: 30901041]
[http://dx.doi.org/10.1192/bjp.bp.115.177683] [PMID: 27388570]
[http://dx.doi.org/10.1192/bjp.2020.225] [PMID: 33176899]
[http://dx.doi.org/10.1016/S2215-0366(18)30141-X] [PMID: 29880238]
[http://dx.doi.org/10.1002/trc2.12078] [PMID: 32864416]
[http://dx.doi.org/10.1001/jama.294.15.1934] [PMID: 16234500]
[http://dx.doi.org/10.1016/S0140-6736(13)62106-6] [PMID: 24183563]
[http://dx.doi.org/10.1007/s11064-014-1293-3] [PMID: 24682754]
[PMID: 30569083]
[http://dx.doi.org/10.1016/j.parkreldis.2020.06.026] [PMID: 32712560]
[http://dx.doi.org/10.1016/j.jamda.2015.06.021] [PMID: 26239690]
[http://dx.doi.org/10.1001/jama.2014.93] [PMID: 24549548]
[http://dx.doi.org/10.1016/j.jalz.2019.06.4946] [PMID: 31587995]
[http://dx.doi.org/10.1212/WNL.0000000000010725] [PMID: 32913021]
[http://dx.doi.org/10.1016/j.jagp.2021.04.014] [PMID: 34059401]
[http://dx.doi.org/10.3390/ijms18122679] [PMID: 29232923]
[http://dx.doi.org/10.1016/j.jagp.2019.06.008] [PMID: 31331724]
[http://dx.doi.org/10.1016/j.jagp.2019.03.016] [PMID: 31126722]
[http://dx.doi.org/10.3390/ijms231810624] [PMID: 36142523]
[http://dx.doi.org/10.1017/S109285291900083X] [PMID: 31010452]
[http://dx.doi.org/10.1080/14656566.2020.1717466] [PMID: 31983254]
[http://dx.doi.org/10.1001/jamanetworkopen.2019.8964] [PMID: 31397865]
[http://dx.doi.org/10.1038/s41398-019-0456-z] [PMID: 30923322]
[http://dx.doi.org/10.1002/alz.12519]
[http://dx.doi.org/10.1136/bmjopen-2019-031947] [PMID: 31857304]
[http://dx.doi.org/10.1017/S1041610217000953] [PMID: 28587701]
[http://dx.doi.org/10.1016/j.jalz.2015.05.017] [PMID: 26096665]
[http://dx.doi.org/10.3233/JAD-170632] [PMID: 29439333]
[http://dx.doi.org/10.3233/JAD-160979] [PMID: 28059789]
[http://dx.doi.org/10.1016/j.jagp.2019.01.215] [PMID: 30902566]
[http://dx.doi.org/10.1017/S1041610219001200] [PMID: 31526407]
[http://dx.doi.org/10.1016/j.jalz.2019.06.872]
[http://dx.doi.org/10.3233/JAD-180131] [PMID: 30175974]
[http://dx.doi.org/10.1017/S1041610218000698] [PMID: 30017017]
[http://dx.doi.org/10.3233/JAD-190278] [PMID: 31177229]
[http://dx.doi.org/10.1002/alz.047673]
[http://dx.doi.org/10.1001/jamapsychiatry.2016.3162] [PMID: 27893026]
[http://dx.doi.org/10.3233/JAD-201184] [PMID: 33554909]
[http://dx.doi.org/10.1002/alz.12007] [PMID: 31914223]
[http://dx.doi.org/10.1177/08919887211016068] [PMID: 34036829]
[http://dx.doi.org/10.1038/s41398-021-01206-z] [PMID: 33500386]
[http://dx.doi.org/10.1212/WNL.0000000000007968] [PMID: 31320470]
[http://dx.doi.org/10.3233/JAD-200011] [PMID: 32597801]
[http://dx.doi.org/10.1002/ajmg.b.32684] [PMID: 30378268]
[http://dx.doi.org/10.1002/dad2.12164] [PMID: 33748395]
[http://dx.doi.org/10.1101/2021.05.20.21257514]
[http://dx.doi.org/10.1017/S1041610218000042] [PMID: 29448970]
[PMID: 33289311]
[PMID: 30619031]