Síntomas de inicio tras el diagnóstico de la demencia:
– Síntomas ligeros o moderados: inhibidores de la colinesterasa (ICE), especialmente la rivastigmina.
– Síntomas moderados o graves: antipsicóticos atípicos a dosis bajas, siempre y cuando el tratamiento con ICE no sea efectivo. Preferiblemente la quetiapina y el aripiprazol.
Síntomas de inicio previo al diagnóstico de demencia:
– Sintomas leves o residuales, no perturbadores: en principio, no tratar.
– Síntomas intensos y perturbadores: antipsicóticos a dosis mayores de las empleadas habitualmente en demencias, preferiblemente con antipsicóticos atípicos y a dosis menores de las empleadas con anterioridad para el tratamiento de su cuadro psicótico.
Advertencias
– Los antipsicóticos en pacientes con demencia tipo Alzheimer incrementan el riesgo cardio y cerebrovascular, aumentando la probabilidad de muerte
– El riesgo en demencias es mayor para los antipsicóticos típicos y, dentro de los atípicos, para la risperidona
– El riesgo en demencias es menor para la quetiapina y el aripiprazol
– En demencia con cuerpos de Lewy la vulnerabilidad a los antipsicóticos puede provocar efectos adversos importantes. En este caso, se recomienda el empleo de quetiapina a bajas dosis
– En la enfermedad de Parkinson, casi todos los antipsicóticos pueden inducir empeoramiento de la clínica parkinsoniana. El primer paso del tratamiento debería ser el ajuste en lo posible de la medicación antiparkinsoniana (reducción o eliminación, por este orden, de los inhibidores de la mono-amino-oxidasa, agonistas dopaminérgicos, l-dopa). Posteriormente se podría tratar con quetiapina o clozapina a bajas dosis
– No está demostrado que los fármacos antipsicóticos presenten un mayor riesgo cardio y cerebrovascular o un mayor riesgo de muerte en demencias diferentes a la enfermedad de Alzheimer
– Con independencia de lo relatado en el apartado anterior, dado el incremento de eventos cardio y cerebrovasculares inducido por la medicación antipsicótica, se recomienda controlar su empleo, utilizando dosis mínimas en presencia de un componente cerebrovascular como origen de la demencia.
Fuente:
Criterios CHROME para la acreditación de centros libres de sujeciones químicas y para una prescripción de psicofármacos de calidad
Javier Olazarán-Rodríguez, Jorge López-Álvarez, Luis F. Agüera-Ortiz, Jesús M. López-Arrieta, Juan L. Beltrán-Aguirre, Pilar García-García, Ana Rigueira-García, Manuel Martín-Carrasco, Domingo J. Quintana-Hernández, Ruben Muñiz-Schwochert.
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Can you be more specific about the content of your article? After reading it, I still have some doubts. Hope you can help me.
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