The latest recommendations from the HAS dated back more than fifteen years… Taking into account the evolution of knowledge, three learned societies (the French Society of Geriatrics and Gerontology – SFGG –, the Federation of Memory Centers – FCM – and the Society French-speaking psychogeriatrics and psychiatry of the elderly – SF3PA) have developed new recommendations on psychological and behavioral symptoms (PCS) in neurocognitive diseases.
Objective : ” help all professionals (doctors from different disciplines but also psychologists, occupational therapists, IDEs, etc.) working with people suffering from neurocognitive diseases presenting with SPC, whatever their place of life (home, nursing home, hospital, etc.) and whatever the neurocognitive disease concerned, to optimize patient care”, summarizes Professor Maria Soto, co-coordinator of these recommendations.
The idea is to get closer to the real lives of patients and their loved ones in order to improve their quality of life. “ The recommendations are very pragmatic and easy to implement in the field, with algorithms and tables to help prescribe pharmacological and non-pharmacological treatments. underlines the geriatrician.
There is also the desire to act preventively by identifying the risk factors associated with PCS as well as the prodromal signs from the beginning or mild stages of the neurocognitive disease.
Know the contributing factors
CPS brings together a wide variety of symptoms such as delusions, hallucinations, depressive symptoms, agitation and aggression, aberrant motor behaviors, disinhibition, anxiety, irritability, sleep or food.
They affect the vast majority of patients (at least 60% of them and up to nearly 90% at some point during their illness) suffering from neurocognitive diseases: Alzheimer’s disease (AD), Lewy body disease, fronto-temporal lobar degeneration, disease of vascular origin, etc.
Patients often have multiple PCS at the same time. Different factors favoring the appearance of CPS could be identified, in particular certain characteristics of caregivers (lack of understanding of the pathology, lack of education on CPS, caregiver exhaustion, etc.). Other factors are linked to the environment: hospitalizations, times of day (meal times, washing, nightfall, etc.), lack of activity, etc. Finally, factors linked to the etiology itself neurocognitive disorders have been noted. The diagnosis of AD is more often associated with the onset of PCS and even before the onset of memory disorders. The duration of the disease and the severity of the disorders seem to play a role.
The appearance of SPC during neurocognitive diseases profoundly modifies the care and prognosis of patients: morbidity and mortality increases, their quality of life decreases and they have greater physical dependence. The presence of SPC leads to more rapid progression of the disease, a greater number of unplanned hospitalizations, and earlier entry into an institution. CPS is also responsible for an increase in caregiver burden.
First-line non-pharmacological treatment
“The first line of treatment for PCS is non-pharmacological. Drug treatments are not the rule and remain second-line, due to their low effectiveness, a limited level of evidence and serious problems of tolerance and serious side effects of psychotropic medications. recalls Professor Maria Soto.
Training professionals to know how to be and how to do remains the key to care
Professor Maria Soto, co-coordinator of HAS recommendations
It is recommended to construct the non-drug intervention (NMI) protocol based on each person’s life history, preferences, interests and skills.
The INM should last between 30 and 60 minutes, at least twice a week, and be ritualized.
The training of professionals (particularly in nursing homes and at home) and caregivers remains the measure benefiting from the highest level of scientific proof for the support of people living with a neurocognitive illness and the management of SPC (higher non-pharmacological interventions themselves and pharmacological treatments of the psychotropic type). “Training professionals to know how to be and how to do remains the key to care”declares Professor Maria Soto.
Spot, identify from the early stages
It is recommended to ask the question of screening and treatment at an early stage. When diagnosing neurocognitive pathologies (even for mild or very mild stages), it is recommended to assess non-cognitive symptoms: psychological and behavioral symptoms, sleep disorders, sensory disorders and more broadly markers of fragility. Finally, we must regularly question the existence of behavioral symptoms without waiting for a possible crisis situation.
What levels of evidence for non-drug treatments?
Non-drug interventions (NMI) with a high level of evidence include: music therapy, adapted physical activity and awareness-raising, training and education interventions for natural caregivers or caregivers. On the other hand, a low level of evidence is put forward for animal-assisted therapy, occupational interventions and art therapy. However, even if an approach does not show scientific proof, it may be of interest in clinical practice.
Interview with Professor Maria Soto (Toulouse University Hospital), co-coordinator of the recommendations
