Experts Explore Neuropsychiatric Symptoms in Alzheimer Disease at Inaugural ADCD Symposium
Key Clinical Summary
- Agitation and psychosis are highly prevalent across neurocognitive disorders; timely identification and treatment reduce hospitalizations, caregiver burden, and functional decline.
- Using structured assessment approaches and screening with validated tools (NPI, CMAI, SAPS) may help successfully identify symptoms.
- Personalized non-pharmacologic strategies may be combined with careful pharmacotherapy to treat neuropsychiatric symptoms (NPS).
On the first day of the inaugural Alzheimer’s Disease and Cognitive Disorders (ADCD) Symposium, meeting Co-Chair Marc E. Agronin, MD, and Carolyn K. Clevenger, DNP, GNP-BC, presented on common neuropsychiatric symptoms that may impact patients with Alzheimer disease (AD). Entitled, “Neuropsychiatric Symptoms in Alzheimer’s Disease: Identification and Intervention Across Disciplines,” the session highlighted evidence-backed, multidisciplinary approaches for diagnosing and addressing these symptoms.
Understanding Neuropsychiatric Symptoms in Alzheimer Disease
“It is estimated that 80 to 90% of all individuals with any sort of neurocognitive disorder at one time or another over the course of their illness will have some form of a neuropsychiatric symptom,” said Dr Agronin, who discussed how symptoms including agitation and psychosis can significantly affect patients’ daily life and disease progression; risk of hospitalization, falls, long-term care placement, and mortality are all heightened in AD patients with NPS.
These symptoms also contribute to caregiver burden. Those who care for individuals with AD and NPS experience increased stress and mortality risk, further highlighting the need for timely intervention.
Identifying and Assessing Symptoms Effectively
Effective intervention is dependent on accurately diagnosing these symptoms, the presenters noted. To do so, Dr Clevenger suggested a structured, holistic approach that involves learning about the patient as a person, obtaining a robust medical and social history, and assessing relevant causes, triggers, or influential factors that could be impacting the patient.
She also recommended several validated tools, including the Neuropsychiatric Inventory (NPI), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, and the Scale for the Assessment of Positive Symptoms (SAPS) for psychosis, to aid in symptom identification.
Approaches to Managing Neuropsychiatric Symptoms
The presenters further recommended that initial treatment plans should employ non-pharmacologic approaches, including sensory interventions, social contact, and behavior therapy, over pharmacologic intervention.
“We like to begin with behavioral or non-pharmacologic approaches and then consider our pharmacologic approaches when non-pharmacologic approaches have been unresponsive, ineffective, or not effective enough,” Dr Clevenger explained.
To close out the session, Dr Agronin shared an overview of the pharmacologic options for NPS management. As he reviewed current evidence for antipsychotics, benzodiazepines, antidepressants, mood stabilizers, and cholinergic agents, Dr Agronin emphasized that older patients may be especially sensitive to medications. He encouraged clinicians to be mindful of potential drug-to-drug interactions and any medical or psychiatric comorbidities that may impact a patient’s treatment response.
For more information about the Alzheimer’s Disease and Cognitive Disorders Symposium, visit the meeting website.
Reference
Agronin M, Clevenger CK. Neuropsychiatric symptoms in Alzheimer’s disease: identification and intervention across disciplines. Presented at: Alzheimer’s Disease and Cognitive Disorders Symposium; November 12-13, 2025; Virtual.
