Pan European Networks - Horizon 2020 - page 50

C
urrent estimates indicate that 35.6 million people
worldwide are living with dementia. This number will
double by 2030 and more than triple by 2050.
Dementia patients experience serious cognitive deficits, and 90%
of them show other non-cognitive behavioural and psychological
symptoms of dementia (BPSD). The spectrum of BPSD includes
verbal and physical aggression, agitation, irritability, wandering,
depression, anxiety and psychosis. These symptoms can decrease
the quality of patients’ lives as well as cause a heavy burden on
caregivers and institutional care units since they require frequent
hospitalisation and constant care. Indeed, the main reason that
elderly people with dementia enter nursing homes or similar
institutions is because family members or caregivers can no
longer manage BPSD. The overwhelming number of people whose
lives are altered by the condition, combined with the staggering
economic burden on families and nations, makes dementia a
public health priority.
Is there any treatment for BPSD?
At present, BPSD are usually treated with second-generation
antipsychotics (SGA) developed to treat schizophrenia. A recent
meta-analysis based on 14 placebo-controlled trials of elderly
patients with BPSD revealed only a small effect for three SGAs,
i.e. risperidone, aripiprazole and olanzapine. In addition,
antipsychotics may produce severe adverse effects including
extrapyramidal symptoms, hyperprolactinaemia, and
cardiovascular and metabolic side effects. Moreover, these drugs
may significantly worsen cognitive functioning, thus accentuating
the underlying cognitive difficulties of the patients.
In 2005, the Food and Drug Administration issued a public health
advisory to warn about a possible increased risk of death among
elderly patients associated with atypical antipsychotics (FDA Public
Health Advisory, 2005) and later in 2008 issued the same warning
about conventional antipsychotics. There are no approved drugs for
dementia-related psychosis and there are no antidepressant, anti-
aggressive or anxiolytic drugs specifically developed to address the
therapeutic needs of an elderly population.
No treatment and nobody is looking for one?
Despite a lack of treatment, BPSD remains ignored by
mainstream pharmaceutical industry drug discovery pipelines as
well as many academic labs. Moreover, it is widely recognised that
geriatric psychiatry and psychopharmacology (similar to child and
adolescent psychiatry) have received relatively little interest from
industry and grant agencies in the last decades, with deleterious
consequences for the real-life quality of patients’ care. Indeed,
safe and effective treatment of BPSD would markedly improve the
standard of care for patients with dementia. As long as the latter
cannot be prevented, it is important to provide optimal
symptomatic relief for patients and caregivers, and realistic
therapeutic healthcare systems.
Could DMLs be a solution?
It has been widely accepted that parallel modulation of multiple
biological targets can be beneficial for treatment of diseases with
Up to 90% of dementia patients suffer from behavioural and physiological
symptoms, including psychosis, depression, aggression, agitation and more …
More than forgetfulness …
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