Magazine article Clinical Psychiatry News

Adviser's Viewpoint: Managing Major Neurocognitive Disorder

Magazine article Clinical Psychiatry News

Adviser's Viewpoint: Managing Major Neurocognitive Disorder

Article excerpt

The Alzheimer's Association suggests that major neurocognitive disorder (formerly known as dementia) caused by Alzheimer's disease is a "silent epidemic" in African Americans, noting that the prevalence among African Americans ranges from 14% to 100% higher than it is among whites.

In April 2013, the National Institute on Aging highlighted a JAMA research article that noted African Americans were more likely to have a variant of the ABCA7 gene and that this gene variant led to almost double the risk of developing Alzheimer's disease (JAMA 2013;309:1483-92).

In addition, the Alzheimer's Association suggests that "African Americans are seriously underrepresented in current clinical trials of potential treatment of Alzheimer's disease, particularly in trials conducted by drug companies." This observation echoes former U.S. Surgeon General David Satcher's 2001 Culture, Race, and Ethnicity report, which underscored a historic dearth of research on African American mental health issues. Recently, a randomized clinical trial of citalopram in agitated patients with Alzheimer's disease found this selective serotonin reuptake inhibitor to be efficacious in reducing agitation. However, African Americans were grossly underrepresented, comprising 15 of 94 patients in the experimental arm of this study (JAMA 2014;311:682-91).

While working on the medical/psychiatric floor at Jackson Park Hospital on Chicago's South Side, I have watched these issues play out in real life, often delivering a harsh reality. For the past 2 years, every day, I have seen one to three elderly African American patients who had been transferred from local nursing homes with complaints of restlessness, wandering, aggression, depression, and psychosis characterized by hallucinations and delusions, which resulted in disruptive behaviors. Clinical lore suggests that such behaviors are responsible for about 50% of admissions to nursing homes and 95% of hospital admissions from such nursing homes.

Despite the known risks, too often, I see patients being prescribed first- and second-generation antipsychotics. I suppose this is because of the agitation, aggression, and psychotic symptoms. But according to the Food and Drug Administration, such prescribing is associated with premature mortality in Alzheimer's disease. I also see a lot of benzodiazepine regimens, and this, too, is occurring despite the recent findings that benzodiazepines are associated with the etiology of Alzheimer's disease. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.