Behavioral and psychiatric symptoms frequently accompany the cognitive deterioration
of dementia occurring in up to 80% of both community-based and nursing home patients.
In Alzheimer's disease (AD), behavioral complications may develop at any stage of the
disease process and tend to follow a more unpredictable course than the core
cognitive symptoms. Over the past 15 years, our knowledge of the biologic and
neurochemical basis of dementia, and of AD in particular, has increased
significantly. Great emphasis has been placed on the cholinergic system abnormalities
in the context of the cognitive impairment in AD and on the psychopharmalogic
enhancement of cholinergic transmission in AD. However deficits in other
neurotransmitter systems, such as the noradrenergic, serotonergic, and dopaminergic
systems, also occur and may contribute to the core cognitive symptoms of AD. More
recently, there has been increased interest in the biologic and neurochemical basis
of behavioral and psychiatric disturbances in dementia. This article reviews the
evidence for biologic and neurochemical correlates of psychosis and agitation in
dementia, and discusses the treatment implications for these findings. (J Geriatr Psychiatry Neurol 1995; 8(suppl 1):S2-S7).
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