Dementia-Related Psychosis and the Potential Role for Pimavanserin
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Dementia-related psychosis is prevalent across dementias and typically manifests as delusions and/or hallucinations. The mechanisms underlying psychosis in dementia are unknown; however, neurobiological and pharmacological evidence has implicated multiple signaling pathways and brain regions. Despite differences in dementia pathology, the neurobiology underlying psychosis appears to involve dysregulation of a cortical and limbic pathway involving serotonergic, GABAergic, glutamatergic, and dopaminergic signaling. Thus, an imbalance in cortical and mesolimbic excitatory tone may drive symptoms of psychosis. Delusions and hallucinations may result from (1) hyperactivation of pyramidal neurons within the visual cortex, causing visual hallucinations, and (2) hyperactivation of the mesolimbic pathway, causing both delusions and hallucinations. Modulation of the 5-HT2A receptor may mitigate hyperactivity at both psychosis-associated pathways. Pimavanserin, an atypical antipsychotic, is a selective serotonin inverse agonist/antagonist at 5-HT2A receptors. Pimavanserin may prove beneficial in treating the hallucinations and delusions of dementia-related psychosis without worsening ognitive or motor function.
Alzheimer's; Parkinson's; Vascular; Frontotemporal; Lewy
Life Sciences | Medical Sciences | Medicine and Health Sciences | Neuroscience and Neurobiology | Neurosciences
Cummings, J. L.,
Devanand, D. P.,
Stahl, S. M.
Dementia-Related Psychosis and the Potential Role for Pimavanserin.