Síntomas neuropsiquiátricos de demencia terminal. Una revisión bibliográfica
DOI:
https://doi.org/10.62954/9eded190Palabras clave:
Demencia, Síntomas Neuropsiquiátricos, Cuidados paliativos, Final de la vida, GeriatríaResumen
Introducción: los Síntomas Neuropsiquiátricos (SNP) son manifestaciones frecuentes y complejas en las fases terminales de la demencia, y representan un reto clínico por su impacto en la calidad de vida, la carga del cuidador y la toma de decisiones al final de la vida. Objetivo: El objetivo de esta revisión narrativa es analizar la evidencia reciente sobre la prevalencia, clasificación, abordaje diagnóstico y tratamiento integral de los SNP en el contexto de demencia terminal. Materiales y métodos: se discuten los principales dominios sintomáticos (afectivo, psicótico, conductual y somático-vegetativo), las herramientas diagnósticas como el Neuropsychiatric Inventory (NPY) traducido a español, Inventario Neuropsiquiátrico, y otras escalas validadas, así como intervenciones no farmacológicas basadas en evidencia y opciones farmacológicas con balance riesgo-beneficio. También se abordan aspectos éticos como la voluntad anticipada, la adecuación del esfuerzo terapéutico y la sedación paliativa, reconociendo el papel fundamental del geriatra como coordinador del plan terapéutico y facilitador del proceso de atención interdisciplinaria. Resultados: Los SNP en demencia terminal requieren una aproximación proactiva, empática y fundamentada en evidencia científica, con especial atención al pronóstico, seguimiento continuo y respeto a la dignidad del paciente. Se identifican áreas prioritarias para investigación futura, incluyendo la validación de escalas pronósticas y la eficacia de intervenciones culturalmente adaptadas Conclusión: Es esencial el manejo de los SNP, se requiere un abordaje integral basado en evidencia. El rol del geriatra es fundamental para una atención de calidad.
Referencias
Booth CL, Lawrence BK. Neuropsychiatric symptoms in dementia: definitions and phenomenology. J Alzheimers Dis. 2021;80(3):993–1002. https://doi.org/10.3233/JAD-201208
Ismail Z, Elahi FM, Russ TC. Neuropsychiatric symptoms in Alzheimer disease: an update. Alzheimers Res Ther. 2024;16(1):45. https://doi.org/10.1186/s13195-024-01215-8
Zhang NK, Zhang SK, Zhang LI, Tao HW, Zhang G-W (2024) The neural basis of neuropsychiatric symptoms in Alzheimer’s disease. Front. Aging Neurosci. 16:1487875. doi: 10.3389/fnagi.2024.1487875
Chen X, Wu Y, Gao Y, Li F. Prevalence of neuropsychiatric symptoms in Alzheimer’s disease: a meta-analysis. J Alzheimers Dis. 2023;85(2):567–580. https://doi.org/10.3233/JAD-230123
Vandenberg AE, Campos L, Zhou T, Tanzi RE. Impact of neuropsychiatric symptoms on caregiver burden and institutionalization. Am J Geriatr Psychiatry. 2022;30(7):709–719.
Huang Y, Martinez C, Tang W. Mortality and behavioral symptoms in end-stage dementia: a cohort study. Int J Geriatr Psychiatry. 2021;36(8):1208–1215.
Nitrini R, Dozzi SM. Demencia: Definición y clasificación. Revista Neuropsicología, Neuropsiquiatría y Neurociencias. 2012;12(1):75-98. Disponible en: http://revistaneurociencias.com/index.php/RNNN/article/view/316/259
Alzheimer Association. Stages of Alzheimer´s. Alzheimers Association. 2025. Disponible en: https://www.alz.org/alzheimers-dementia/stages
World Health Organization. Dementia: Key facts [Internet]. Geneva: WHO; 2024 [cited 2025 Jun 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia
GBD 2019 Dementia Forecasting Collaborators. Estimation of global dementia prevalence and burden from 2019 to 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105–e125. https://doi.org/10.1016/S2468-2667(21)00249-8
Sleeman KE, de Brito M, Etkind SN, Nkhoma K, Higginson IJ, Gomes B. The escalating global burden of serious health-related suffering: projections to 2060. Lancet Glob Health. 2019;7(7):e875–e882. https://doi.org/10.1016/S2214-109X(19)30172-X
Li Z, Yang N, He L, Wang J, Yang Y, Ping F. Global Burden of Dementia Death from 1990 to 2019, with Projections to 2050: An Analysis of 2019 Global Burden of Disease Study. J Prev Alzheimers Dis. 2024;11(4):1013–1021. doi:10.14283/jpad.2024.21
Alzheimer’s Disease International. World Alzheimer Report 2024: Redesigning dementia care. London: ADI; 2024 [cited 2025 Jun 17]. Available from: https://www.alzint.org/resource/world-alzheimer-report-2024
Tran T, Diniz BS, Geda YE. Disruption of brain circuits in neurodegenerative disease and neuropsychiatric symptoms: an updated review. Nat Aging Neurosci. 2024;4(1):23–35.
Santos MA, Lima GZ, Moreira RP. Overlap of depression, anxiety and cognitive decline in neurodegeneration. Nat Aging Neurosci. 2024;4(3):178–187.
González-Mendoza D, Ríos-Zertuche D, Vázquez-Ramos C. Interacciones entre multimorbilidad y síntomas neuropsiquiátricos en demencia avanzada. Arq Neuropsiquiatr. 2023;81(4):321–329.
Parra MA, Baez S, Allegri R, Nitrini R, Lopera F, Slachevsky A, et al. Dementia in Latin America. Assessing the present and envisioning the future. Neurology. 2018;90(5):222-231. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5791795/
Velázquez-Pérez L, Ruiz-Mendoza R, Morales-Cárdenas A, et al. Sistema de vigilancia epidemiológica de las demencias en México: resultados 2022. Rev Neurol Mex. 2023;46(Suppl 1):15–29.
Prince M, Acosta D, Ferri CP, Guerra M, Huang Y, Llibre Rodriguez JJ, Salas A, Sosa AL, Williams JD, Dewey ME, Acosta I, Jotheeswaran AT, Liu Z. Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. Lancet. 2012;380(9836):50-8. doi: 10.1016/S0140-6736(12)60399-7.
Downer B, Kumar A, Espino DV, Raji MA, Ottenbacher KJ. Neuropsychiatric symptoms across cognitive impairment levels in Mexican American adults aged 85 and older. J Am Geriatr Soc. 2021;69(3):789–796.
Gómez L, Reyes GS, Silva MC, López G, Cárdenas MC. Etiología, factores de riesgo, tratamientos y situación actual de la enfermedad de Alzheimer en México. Gac Med Mex. 2022;158(4). Disponible en: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0016-38132022000400244
Robles A, Díaz GJ, Reinoso S, González A, Vázquez C, García AA. Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados: estudio transversal multicéntrico. Rev Esp Geriatr Gerontol. 2012;47(3):96-101. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0211139X12000571
Guerra Hernández M.A., Llibre Guerra J.J., García Arjona L. Síntomas psicológicos y conductuales en adultos mayores con diagnóstico de demencia. Panorama Cuba y Salud. 2011;6(2-3):20-25. Recuperado de: https://www.redalyc.org/articulo.oa?id=477348945005
Pascual LF. Calidad de Vida y Demencia. Rev Neurol. 1998;26(152):582-58. Disponible en: https://files.neurologia.com/journal/RN/26/152/10.33588/rn.26152.981029/pdf/40960416237cb41c80e3a0ec43443e52.pdf
Mattap SM, Mohan D, McGrattan AM, Allotey P, Stephan BCM, Reidpath DD. The economic burden of dementia in low- and middle-income countries: a systematic review. BMJ Glob Health. 2022;7(2):e007409. https://doi.org/10.1136/bmjgh-2021-008465
Mejía-Arango S, Gutiérrez LM, Nevares RE. Neuropsychiatric symptoms and 6-year mortality in cognitively normal older Mexican adults. J Hosp Palliat Nurs. 2025;27(2):95–102.
Jiménez-Corona A, Samper-Ternent R, Ottenbacher KJ, et al. Prevalence and impact of neuropsychiatric symptoms in Hispanic populations with neurodegenerative disease: evidence from population-based studies. Alzheimers Res Ther. 2023;15(1):112.
Swann P, Mirza-Davies A, O’Brien J, et al. Associations between neuropsychiatric symptoms and inflammation in neurodegenerative dementia: a systematic review. J Neuroinflammation. 2024;17:6113-6141. doi:10.2147/JIR.S385825.
Ouabes S, Popp J. High Cortisol and the Risk of Dementia and Alzheimer´s Disease: A Review of the Literature. 2019;11:43. https://doi.org/10.3389/fnagi.2019.00043
Sanmarco LM, et al. CSF cortisol levels predict neuropsychiatric symptom severity in MCI and Alzheimer’s disease: systematic review. Dement Neuropsychol. 2024;10(2):101–110.
Ennis GE, et al. High cortisol levels accelerate cognitive decline in MCI: cohort study. Alzheimers Res Ther. 2023;15(3):56.
Arvanitakis Z, Shah R, Bennett DA. Diagnosis and Management of Dementia: A Review. JAMA. 2019;322(16):1589-1599. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC7462122/pdf/nihms-1622652.pdf
Leung DKY, Chan WC, Spector A, Wong GHY. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2021;36(9):1330–1344. https://doi.org/10.1002/gps.5556
Chatzikostopoulos A, Moraitou D, Papaliagkas V, Tsolaki M. Mapping the Neuropsychiatric Symptoms in Alzheimer’s Disease Using Biomarkers, Cognitive Abilities, and Personality Traits: A Systematic Review. Diagnostics. 2025;15:1082. doi:10.3390/diagnostics15091082
Anantapong K, Jiraphan A, Aunjitsakul W, Sathhaporn K, Werachattawan N, Teetharatkul T, et al. Behavioural and psychological symptoms of people with dementia in acute hospital settings: a systematic review and meta-analysis. Age Ageing. 2025;54(1):afaf013. https://doi.org/10.1093/ageing/afaf013
Barojas KJ. Necesidad de Adecuación Transcultural de la Herramienta 4 AT en personal de salud mexicano que atiende Adultos Mayores del Servicio de Geriatría del Hospital Central “Dr. Ignacio Morones Prieto. Universidad Autónoma de San Luis Potosí. 2025. Disponible en: https://repositorioinstitucional.uaslp.mx/xmlui/bitstream/handle/i/9319/TesisE.FM.2025.Necesidad.Barojas.pdf
Teno JM, Gozalo PL, Bynum JPW, Leland NE, Miller SC, Morden NE, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470–477. https://doi.org/10.1001/jama.2012.207624
Hachimi-Idrissi S, Vandewoude M, Fieuws S, et al. End-of-life decision making and palliative care in advanced dementia: a prospective cohort study. BMC Palliat Care. 2024;23(1):54.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314. https://doi.org/10.1212/WNL.44.12.2308
Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci. 2000;12(2):233–239. https://doi.org/10.1176/jnp.12.2.233
Wood S, Cummings JL, Hsu MA, Veen Wheatley M, Yarema KT, Schnelle JF. The use of the Neuropsychiatric Inventory in nursing home residents: characterization and measurement. Am J Geriatr Psychiatry. 2000;8(1):75–83. https://doi.org/10.1097/00019442-200002000-00010
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1988;23(3):271–284. https://doi.org/10.1016/0006-3223(88)90038-8
Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989;44(3):M77–M84. https://doi.org/10.1093/geronj/44.3.M77
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res. 1991;38(2):143–162. https://doi.org/10.1016/0165-1781(91)90040-V
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9–15. https://doi.org/10.1097/01.JAM.0000043422.31640.F7
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Abraha I, Rimland JM, Trotta FM, Dell’Aquila G, Cruz-Jentoft A, Petrovic M, et al. Systematic review of non-pharmacological interventions for behavioral and psychological symptoms of dementia: an update. J Am Med Dir Assoc. 2017;18(6):515.e1–515.e20.
Cohen-Mansfield J, Marx MS, Thein K, Dakheel-Ali M. The impact of stimuli on affect in persons with dementia. J Clin Psychiatry. 2012;73(1):e23–e28. https://doi.org/10.4088/JCP.10m06447
Richards C, Beck C, O’Sullivan PS, Shue VM. Effect of individualized social activity on sleep in nursing home residents with dementia. J Am Geriatr Soc. 2005;53(9):1510–1517. doi: 10.1111/j.1532-5415.2005.53460.x
Maher AR, Maglione M, Bagley S, Suttorp M, Hu JH, Ewing B, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011;306(12):1359-69. doi: 10.1001/jama.2011.1360.
Ballard C, Corbett A, Howard R. Prescription of antipsychotics in people with dementia. Br J Psychiatry. 2014;205(1):4-5. doi: 10.1192/bjp.bp.113.128710.
Schneider LS, Dagerman KS, Insel PS. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294(15):1934–1943. https://doi.org/10.1001/jama.294.15.1934
Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014;62(4):762–769. https://doi.org/10.1111/jgs.12730
Mintzer JE, Tune LE, Breder CD, Swanink R, Marcus RN, McQuade RD, et al. Aripiprazole for the treatment of psychoses in institutionalized patients with Alzheimer dementia: a multicenter, randomized, double-blind, placebo-controlled assessment of three fixed doses. Am J Geriatr Psychiatry. 2007;15(11):918–31. doi: 10.1097/JGP.0b013e3181557b47.
Porsteinsson AP, Drye LT, Pollock BG, Devanand DP, Frangakis C, Ismail Z, et al. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA. 2014;311(7):682–691. https://doi.org/10.1001/jama.2014.93
Seitz DP, Adunuri N, Gill SS, Gruneir A, Herrmann N, Rochon P. Antidepressants for agitation and psychosis in dementia. Cochrane Database Syst Rev. 2011;2011(2):CD003946. doi: 10.1002/14651858.CD008191.pub2.
Rosenberg PB, Lanctôt KL, Drye LT, Herrmann N, Scherer RW, Bachman DL, et al. Safety and efficacy of methylphenidate for apathy in Alzheimer’s disease: a randomized, placebo-controlled trial. J Clin Psychiatry. 2013;74(8):810–816. doi: 10.4088/JCP.12m08099.
Wang LY, Shofer JB, Rohde K, et al. Trazodone for behavioral symptoms of dementia: a randomized placebo-controlled study. Am J Geriatr Psychiatry. 2021;29(3):252–262.
Candy B, Jones L, Goodman ML, et al. Interventions for delirium at the end of life in people with cancer. Cochrane Database Syst Rev. 2015;2015(3):CD009527.
Mercadante S, Adile C, Ferrera P, Casuccio A. Sedation for uncontrolled symptoms in terminally ill patients with cancer: a longitudinal study. J Pain Symptom Manage. 2009;37(3):298–306.
Holmes HM, Sachs GA, Joseph W, Hougham GW, Cox-Hayley D, Dale W. Integrating Palliative Medicine into the Care of Persons with Advanced Dementia: Identifying Appropriate Medication Use. J Am Geriatr Soc. 2008;56(7):1306-1311. https://doi.org/10.1111/j.1532-5415.2008.01607.x
Todd A, Holmes HM, Pearson SA, et al. The challenge of deprescribing in older people with multimorbidity. Age Ageing. 2020;49(4):558–564.
Garrafa V, Pessini L, Barchifontaine CP. Bioethics, dementia, and advance directives: Latin American perspectives. J Aging Stud. 2023;66:101092.
Mitchell SL, Teno JM, Miller SC, Mor V. A national study of the treatment of dying nursing home residents with advanced dementia. N Engl J Med. 2009;361(16):1529–38. https://doi.org/10.1056/NEJMsa0902234
Costa DJ, Roriz-Cruz M, Moacyr JC, et al. Palliative sedation in dementia: a multicenter prospective cohort study. J Palliat Med. 2023;26(4):435–443.
Ryan T, Ingleton C, Gardiner C, Parker C, Gott M. Improving care for people with advanced dementia approaching the end of life. Palliat Med. 2022;36(1):32–43. https://doi.org/10.1177/02692163211038858
Gitlin LN, Kales HC, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in community settings. Neurologist. 2012;18(6):325–333. https://doi.org/10.1097/NRL.0b013e318272ca83
Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry. 2012;169(9):946–953. https://doi.org/10.1176/appi.ajp.2012.11101529
Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139(9):1136–1139. https://doi.org/10.1176/ajp.139.9.1136
Mitchell SL, Miller SC, Teno JM, Mor V. Medicare hospice criteria and recognition of terminal status in patients with advanced dementia: implications for palliative care. J Palliat Med. 2022;25(5):684–691.
Díaz-Venegas C, Sáenz JL, Wong R. Comparative health assessments between older adults in the United States and Mexico: role of the geriatrician. J Aging Health. 2020;32(7–8):387–397. https://doi.org/10.1177/0898264320921346
Espinoza SE, Gómez FA, Ruiz AV, et al. Prevalence and impact of frailty in people with dementia: a systematic review and meta-analysis. Lancet Healthy Longev. 2024;5(7):e398–e410.
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