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Boot, Brendon

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Boot

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Brendon

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Boot, Brendon
Author's Publications: search.filters.isAuthorOfPublication.e2e3de3e-1854-45ab-b1cd-8b471d2e2615

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    Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms
    (Elsevier, 2017) Lanctôt, Krista L.; Amatniek, Joan; Ancoli-Israel, Sonia; Arnold, Steven E.; Ballard, Clive; Cohen-Mansfield, Jiska; Ismail, Zahinoor; Lyketsos, Constantine; Miller, David S.; Musiek, Erik; Osorio, Ricardo S.; Rosenberg, Paul B.; Satlin, Andrew; Steffens, David; Tariot, Pierre; Bain, Lisa J.; Carrillo, Maria C.; Hendrix, James A.; Jurgens, Heidi; Boot, Brendon
    Neuropsychiatric symptoms (NPSs) are hallmarks of Alzheimer's disease (AD), causing substantial distress for both people with dementia and their caregivers, and contributing to early institutionalization. They are among the earliest signs and symptoms of neurocognitive disorders and incipient cognitive decline, yet are under-recognized and often challenging to treat. With this in mind, the Alzheimer's Association convened a Research Roundtable in May 2016, bringing together experts from academia, industry, and regulatory agencies to discuss the latest understanding of NPSs and review the development of therapeutics and biomarkers of NPSs in AD. This review will explore the neurobiology of NPSs in AD and specific symptoms common in AD such as psychosis, agitation, apathy, depression, and sleep disturbances. In addition, clinical trial designs for NPSs in AD and regulatory considerations will be discussed.
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    Comprehensive treatment of dementia with Lewy bodies
    (BioMed Central, 2015) Boot, Brendon
    Dementia with Lewy bodies is an under-recognized disease; it is responsible for up to 20 % of all dementia cases. Accurate diagnosis is essential because the management of dementia with Lewy bodies is more complex than many neurodegenerative diseases. This is because alpha-synuclein, the pathological protein responsible for dementia with Lewy bodies (and Parkinson’s disease), produces symptoms in multiple domains. By dividing the symptoms into cognitive, neuropsychiatric, movement, autonomic, and sleep categories, a comprehensive treatment strategy can be achieved. Management decisions are complex, since the treatment of one set of symptoms can cause complications in other symptom domains. Nevertheless, a comprehensive treatment program can greatly improve the patient’s quality of life, but does not alter the progression of disease. Cholinesterase inhibitors are effective for cognitive and neuropsychiatric symptoms; rivastigmine has the widest evidence base. Special care needs to be taken to avoid potentially fatal idiopathic reactions to neuroleptic medications; these should be used for short periods only when absolutely necessary and when alternative treatments have failed. Pimavanserin, a selective serotonin 5-HT2A inverse agonist, holds promise as an alternative therapy for synuclein-associated psychosis. Levodopa/carbidopa treatment of parkinsonism is often limited by dopa-induced exacerbations of neuropsychiatric and cognitive symptoms. Autonomic symptoms are under-recognized complications of synucleinopathy. Constipation, urinary symptoms and postural hypotension respond to standard medications. Rapid eye movement sleep behavior disorder is highly specific (98 %) to the synucleinopathies. Nonpharmacological treatments, melatonin and clonazepam are all effective.