Managing Behavioral Dyscontrol Related to Dementia

Dementia of the Alzheimer’s type involves both a cognitive and a behavioral domain. Behavioral and psychotic symptoms in dementia are defined as a heterogeneous range of psychological reactions and psychiatric symptoms and behaviors resulting from the presence of dementia. Symptoms include psychosis, agitation/aggression, anxiety, depression, apathy, and sleep disturbance. Multiple brain and neurochemical deficits may act as catalysts for these symptoms. Like other patients suffering from symptoms of aggression, patients with dementia have serotonin deficits as well as a loss of serotonin receptors in cerebrospinal fluid and the raphe nuclei. Patients with Alzheimer’s type dementia additionally appear to have functionally hyperresponsive serotonin systems that likely contribute to aggressive behavior, and there is an apparent association between serotonin responsiveness and agitation in these patients. The relationship between serotonin and aggression provides a rationale for the use of serotonin antagonists to aid in the management of the behavioral and cognitive symptomatology inherent to Alzheimer’s type dementia.