Navigating Neuropsychology

120| Apathy and Agitation in Neurodegenerative Diseases – A Conversation With Dr. Krista Lanctôt

21 snips
Jun 1, 2023
Dr. Krista Lanctôt, an expert in neuropsychiatric symptoms in older adults with neurodegenerative diseases, discusses apathy and agitation. The topics include diagnose criteria, epidemiology, relation to neuropathology, different treatment approaches, and challenges faced by caregivers.
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INSIGHT

Methylphenidate Shows Modest Efficacy For Apathy

  • Methylphenidate (norepinephrine-dopamine reuptake inhibitor) targets fronto-striatal reward circuitry and shows modest, replicable benefit for apathy.
  • ADMET-2 demonstrated tolerability and efficacy even alongside psychosocial interventions and other meds.
ADVICE

Use NPI Apathy ≥4 As A Practical Screen

  • For trial or clinic screening, an NPI apathy subscore ≥4 reliably identifies patients meeting apathy diagnostic criteria.
  • Use NPI apathy as a pragmatic clinical screen when full diagnostic assessment is impractical.
ADVICE

Consider TMS, Not Yet TDCS, For Apathy

  • Consider non-invasive brain stimulation (TMS) for apathy; evidence is emerging but limited and needs larger trials.
  • TDCS currently lacks sufficient evidence despite home-use feasibility.
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