La disabilita’ mentale nella malattia di alzheimer e nelle altre demenze degenerative - Mental disability in Alzheimer's disease and other degenerative dementias

Background: In recent years the high prevalence of mental disability in patients suffering from dementia has brought greater attention to aspects such as its impact on prognosis and rehabilitation, the levels of stress induced on the patients and the caregivers and the increased social costs it entails. In addition to cognitive deficits, other and more important factors are associated to mental disability in these patients, a constellation of the so-called behavioural and psychological symptoms of dementia (BPSD). Materials and methods: In this review, the latest developments in BPSD treatment are analyzed considering their nosographic profile, their clinical expression and their usefulness in the differential diagnosis amongst the three main types of degenerative dementias (Alzheimer's disease, dementia with Lewy bodies, fronto-temporal degeneration). Aim of this paper: The neurobiological, genetic and neurochemical mechanisms supposed to be at the heart of the pathogenesis of BPSD as well as the most recent contributions provided by the anatomical and functional neuroimaging techniques are discussed. Their psychological and social correlates are reviewed as well as the main tools and scales used in clinical assessment. Aim of this paper: Finally we discuss the bioethical issues at the root of BPSD treatment. Recently in Italy there has been an initial proposal for a shared approach by the national scientific societies involved in the clinical management of these symptoms