Neuropsychiatry: Managing Psychiatric Manifestations of Neurologic Disorders

In this issue of Practical Neurology, we present a comprehensive overview of neuropsychiatric symptoms (NPS) across several prominent neurologic conditions. Authored by academic and clinical experts along with junior colleagues, these articles highlight the significant impact of NPS on patient quality of life, caregiver burden, and disease progression, while also exploring current diagnostic approaches and management strategies.

The first article by Dr. Grossberg along with Kimmy Maguire and Maureen Cranley delves into the 4 most prevalent neuropsychiatric symptoms seen in those living with Alzheimer disease: depression, apathy, psychosis, and agitation. The authors emphasize the importance of early identification and individualized treatment approaches, noting that although nonpharmacologic strategies may be the cornerstone of care, the judicious use of pharmacologic therapies is often necessary, despite potential side effects in the geriatric population. 

The next article by Drs. Aziz and Parelukar with Jonathan Krantz focuses on the diverse neuropsychiatric manifestations of frontotemporal dementia (FTD), including those seen in behavioral variant FTD and primary progressive aphasias.The authors advocate for a multidisciplinary approach to management, with a strong emphasis on caregiver education and nonpharmacologic interventions. 

The article by Drs. Sheheryar and Redden with Poorva Sheth and Avrie Barthel provides an in-depth look at the highly prevalent neuropsychiatric symptoms seen in those living with Lewy body dementia. The authors discuss the complex etiology of these symptoms, the challenges in differentiating them from other dementia subtypes, and a range of nonpharmacologic and pharmacologic management strategies, emphasizing a cautious, individualized approach due to potential side effects and the need for evidence from disease-specific clinical trials.

Next, Drs. Pandey and Thomas examine NPS associated with multiple sclerosis (MS), moving beyond the traditional view of MS as solely a motor and cognitive disorder. It explores the biological basis for symptoms such as depression, anxiety, bipolar disorder, pseudobulbar affect, psychosis, and fatigue, linking them to inflammatory, demyelinating, and neurodegenerative changes in the central nervous system.

Drs. Chand and Goodland writing with Elisabeth DeMarco and Monica Goodland highlight the significant burden of depression, anxiety, and psychosis seen in those diagnosed with Parkinson disease. The article provides evidence-based recommendations for both pharmacologic and nonpharmacologic management, including optimization of dopamine replacement therapy, various antidepressant and anxiolytic options, and noninvasive brain stimulation techniques.

Lastly, Dr. Cruz-Flores with Diego Silva-Mendoza and Eduardo Zesati explore the NPS commonly associated with vascular dementia, including mood disorders (depression, apathy, emotional lability), agitation, behavioral disturbances, and psychotic symptoms. The article outlines current management strategies, emphasizing a multidisciplinary approach that combines pharmacologic interventions (antidepressants, atypical antipsychotics, cholinesterase inhibitors) with nonpharmacologic methods, such as cognitive behavioral therapy, environmental modifications, and physical activity. 

Together, these articles advocate for a holistic, individualized, and often multidisciplinary approach to patient care, recognizing that effective management of these symptoms is crucial for improving patient outcomes and alleviating caregiver burden.