Emerging treatments for the behavioral and psychological symptoms of dementia Abhinav Anand, 1 Puneet Khurana, 2 Jasneet Chawla, 3 Neha Sharma, 1 and Navneet Khurana 1 * 1 Department of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India 2 Punjab Institute of Medical Sciences, Jalandhar, Punjab, India 3 SPS Hospital, Sherpur Chowk, Sherpur, Ludhiana, Punjab, India Dementia is referred to a loss of memory and decline in other mental abilities at levels critical enough to hinder performance of daily activities. It can be of several types, depending on the underlying pathophysiology. The behavioral and psychological symptoms of dementia (BPSD) are various, but the most clinically significant are depression, apathy, and anxiety. Other BPSD include agitation, aberrant motor behavior, elation, hallucinations, and alterations in sleep and appetite. About 90% of sufferers of dementia are affected by BPSD during the course of the illness. These symptoms occur in demented patients irrespective of the dementia subtype. However, there has not been significant development in the areas of disease-modifying pharmacotherapeutics for dementia. Therefore, tackling BPSD has emerged as a research avenue in the recent past. Existing antidepressants, antipsychotics, and cholinergic agents have been extensively used in the treatment of BPSD, independently and in different combinations. However, these agents have not successful in completely alleviating such symptoms. Research in this field is going on globally, but it is still limited by various factors. There is a strong need to develop new entities and test them clinically. This review focuses on emerging treatments for the management of clinically significant BPSD. Received 28 June 2017; Accepted 24 July 2017 Key words: Anxiety, apathy, behavioral and psychological symptoms of dementia, dementia, depression, emerging treatments. Introduction Dementia is more of an aggregation of symptoms affecting memory, cognition, and social abilities on a severe magnitude than a disease per se. These adverse effects on the performance of the activities of daily life result from physical changes in the brain. Dementia can further be of several types, depending on the underlying pathological condition and symptoms, as described in Table 1. 1,5-14 Dementias are progressive in nature. The sufferers may have trouble with short-term memory in the beginning, which evolves into a total loss of memory. While the symptoms of dementia are various, impairment in at least two of the following core mental functions should be there for the condition to be considered as dementia: ▪ memory ▪ language and communication ▪ ability to focus ▪ capability to reason and judge ▪ visual perception 2 Apart from dementia, cognitive impairment may manifest without any functional impairment. This syndrome is known as mild cognitive impairment. 3 Studies with community samples have revealed that its progression to dementia is about 12–15% annually, on average. 4 The behavioral and psychological symptoms of demen- tia (BPSD) are a conglomeration of non-cognition- associated symptoms and behavioral problems manifested in patients suffering from dementia. These are also known as “neuropsychiatric symptoms.” BPSD comprise a sig- nificant component of dementia independent of subtype. In the beginning stages of cognitive impairment, BPSD appear in about 35–85% of patients with mild cognitive impairment. 15 These symptoms occur very frequently. About 90% of demented patients clinically present with at least one of the BPSD. These symptoms may fluctuate during the progression of dementia. BPSD may vary in the short term, either via pharmacological and/or * Address correspondence to: Navneet Khurana, Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar–Delhi G.T. Road, NH-1, Phagwara, Punjab, India 144411. (Email: navi.pharmacist@gmail.com) CNS Spectrums, page 1 of 9. © Cambridge University Press 2017 doi:10.1017/S1092852917000530 REVIEW ARTICLE https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1092852917000530 Downloaded from https://www.cambridge.org/core. IP address: 207.241.231.82, on 18 Jul 2018 at 22:34:24, subject to the Cambridge Core terms of use, available at