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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Science of Psychiatry: Making an Impact

       

This piece of research was taken from 'Research and psychiatry - making an impact'

Dealing with the psychiatric symptoms of dementia

University
Newcastle
Type of research
Clinical
Topic
Dementia
Impact on
 —
Therapy type
Pharmacological
 

There are various types of dementia and the numerous symptoms include anxiety, delusions and hallucinations. Researchers at Newcastle University realised that a type of drug used for one type of dementia might have benefits for others. These drugs are now used internationally for two types of dementia that previously had no effective treatment.

Dementia is one of the greatest problems facing society today. It affects over 35 million people worldwide, including nearly five per cent of people aged over 65. Not only does it impact greatly on the quality of life of sufferers and care-givers, but it has huge financial implications.

There are a number of types of dementia which originate in different ways and have a variety of symptoms. Dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) make up around 20% of dementias in older people and they are characterised by persistent and disabling psychiatric symptoms. They cannot be managed using standard anti-psychotic treatments because they can cause severe, even fatal, reactions in these patients.

Memory loss is a key symptoms of dementia and researchers developed drugs to be used for Alzheimer’s disease that preserve communication between brain cells by reducing the breakdown of the neurotransmitter acetylcholine. These drugs are known as cholinesterase inhibitors (CHEIs) and were found to significantly improve cognition and activities of daily living.

In the early 1990s, Newcastle researchers showed that there was a greater deficiency of acetylcholine in brain tissue of patients with DLB than those with Alzheimer’s disease. The researchers realised that CHEIs might be even more beneficial in patients with dementia with Lewy bodies.

Following early feasibility studies in Newcastle, Professor McKeith led the first multi-centre trial, which demonstrated that CHEIs were indeed effective in people with dementia with Lewy bodies. The results of this study showed that patients given the CHEI rivastigmine exhibited significantly fewer psychotic symptoms such as delusion and hallucination, and were significantly faster and better scoring at computerised cognitive tests than the placebo group.

This work paved the way for similar treatment to be applied in Parkinson’s disease dementia. The results of a preliminary trial by the same group of Newcastle investigators indicated that patients given rivastigmine showed significant improvement over baseline scores in terms of hallucinations, sleep disturbance and cognitive scores, and that caregiver distress was also signifi cantly reduced.

A parallel study of the CHEI donepezil, in both DLB and PDD patients, confirmed these effects, and gave the first indication of clinical efficacy and acceptable side effects in these two populations. CHEIs are now widely recommended for use in both dementia with Lewy bodies and Parkinson’s disease dementia in the UK and throughout Europe. Since 2009, we have now been able to manage some of the most distressing symptoms of these severely debilitating diseases.

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