New trends in pharmacological control of neuropsychiatric symptoms of dementia

Abnormal neuronal and synaptic plasticity occurs in Alzheimer's disease (AD) and depression. The latter, particularly latelife, has been recognized as fundamental in the identification of at-risk prodromal stages of AD. The lack of disease-modifying drugs and the off-label use of antipsychotics and antidepressants for neuropsychiatric symptoms (NPSs) have caused a season of therapeutic inappropriateness. To date, the wealth of clinical trials investigating drugs, diverse for structure and mechanism of action, has failed to provide a cure for all the spectrums of NPSs. Psychedelics in microdosing afford promotion of neurogenesis and synaptic plasticity and, recently, have been considered a revolution for the management of depression endowed with faster action and an improved side effect profile than antidepressants. In the current scenario, therefore, the rapid-acting antidepressant esketamine could represent the first-in-class for treatment of NPSs, and this deserves to be demonstrated with an open-label clinical trial.

Automated summary

Abnormal neuronal and synaptic plasticity are present in Alzheimer's disease and depression. Current drug therapies for treating neuropsychiatric symptoms have not been able to provide a complete cure, despite numerous clinical trials investigating drugs with different structures and mechanisms of action.