Tratamento farmacológico dos sintomas relacionados à agitação e ao comportamento agressivo em pacientes com Doença de Alzheimer no Distrito Federal

Abstract

Background: Neuropsychiatric symptoms such as aggression and agitation are observed frequently in Alzheimer’s disease (AD), affecting around 90% of patients over the course of illness. Although non-pharmacological strategies are the first-line treatment for these behavioral symptoms, off-label use of antipsychotics and antidepressants has also been proposed as an alternative. Objective: To assess patterns of clinical treatment of agitation and aggressive behavior in patients with AD treated at specialist outpatient clinics in the Federal District of Brazil. Methods: This naturalistic, multicenter, cross-sectional study was conducted in a convenience sample of patients with AD (according to DSM-5 criteria) who exhibited behavioral symptoms of aggression and/or agitation during outpatient visits, according to the Neuropsychiatric Inventory (NPI), and were deemed to require pharmacological intervention. The sample was recruited in 2018–2020 at 11 AD treatment centers operated by the Federal District Department of Health. Sociodemographic and clinical data were collected during routine visits. Descriptive statistics were used for analysis, calculating frequencies for categorical variables and measures of position for continuous variables. Results: The sample comprised 369 older adults with a mean age of 82.3 ± 7.7 years. The drugs most used for behavioral control were antidepressants (79.1%), acetylcholinesterase inhibitors (76.6%), antipsychotics (70.2%), memantine (30.9%), and mood stabilizers (9.5%). Just 10.6% were prescribed benzodiazepines. The most common pharmacological treatment regimen, prescribed to 21% of patients, was a combination of antipsychotics, an antidepressant, and an acetylcholinesterase inhibitor. Quetiapine was the antipsychotic most often used (48.5%), at a mean dose of 57.4 ± 40.7mg. Citalopram was the most widely used of the antidepressants (32.0%), at a mean daily dose of 24.1 ± 8.1mg. Conclusions: Controlling the SNP represents an extra challenge in the treatment of these complex and fragile patients. Critical and regional information can help health professionals to avoid damage caused at various decision points, since the prescription is prescribed for elderly populations with dementia and its monitoring with a comprehensive look is a daily challenge for doctors and staff multidisciplinary health professionals. Health education actions are needed for prescribers and other health professionals, for whom the neuropsychiatric symptoms is diagnosed early and with appropriate treatment be instituted, non-pharmacological and pharmacological.