S55. THERAPEUTIC MANAGEMENT OF PATIENTS DIAGNOSED WITH SCHIZOPHRENIA AND MAJOR NEUROCOGNITIVE DISORDER DUE TO ALZHEIMER’S DISEASE - A CASE SERIES

Abstract

Background: Patients with schizophrenia present a higher risk for the development of neurocognitive disorders, according to data in the literature [1]. A common pathogenic background has been reported as being the dysfunction of the N-methyl-D-aspartate receptors, and memantine was associated with positive results over the severity of negative symptoms in schizophrenia [2]. Evidence-based treatments for patients diagnosed with neurocognitive disorders and schizophrenia are, however, scarce. Method(s): Four patients, diagnosed with schizophrenia and major neurocognitive disorder due to Alzheimer's disease (according to the DSM-5 criteria) were evaluated from clinical and psychological perspective, using Mini-Mental Status Examination (MMSE), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), and Clinical Global Impression- Severity (CGI-S). Patients received treatment with antipsychotic and neurocognitive enhancers, and they were evaluated after 4, 8, and 12 weeks of treatment. Result(s): The first patient was a female, 66 years old, diagnosed with schizophrenia for more than 20 years, currently in remission under treatment with oral atypical antipsychotic, who was brought by her family to hospital for gradually onset of memory deficits, combined with visuo-spatial tasks difficulty and expressive aphasia. She was initiated on rivastigmine patch 4.6 mg, and her current antipsychotic treatment was maintained. The second patient was a male, 70 years old, diagnosed with schizophrenia for at least 40 years, currently on oral typical antipsychotic, was diagnosed with major neurocognitive disorder due to Alzheimer's disease based on clinical, neuroimagistic, and psychological evaluations. He was initiated on memantine and titrated up to 20 mg QD, and he was switched on an atypical antipsychotic without anticholinergic properties. The third patient was 65 years old, female, with long history of schizophrenia (first documented diagnosis was 32 years ago), presented herself to a psychiatric evaluation accusing memory and attentional deficits. She received an atypical antipsychotic for the residual symptoms of her psychosis (she discontinued her treatment more than 6 months ago), and memantine was also titrated up to 20 mg QD. The fourth patient was a 62-year old male, diagnosed with schizophrenia 40 years ago, currently undergoing injectable long-acting atypical antipsychotic, and presenting gradually onset of memory deficits. Donepezil was initiated and titrated up to 10 mg QD. Mean baseline MMSE score for these patients was 17.5. All patients registered positive evolution of their PANSS score compared to baseline (p=0.04), a minimal variation of MMSE after 12 weeks, and improvements of GAF and CGIS, although not statistically significant. No significant adverse events were reported during the 3 months of monitoring. Discussion(s): Evaluation of memory, attentional, and executive functions in patients with long history of schizophrenia is useful in order to detect as early as possible the onset of a neurocognitive disorder. A cholinesterase inhibitor for early and moderate phase of the neurocognitive disorder, or memantine for moderate and severe phase of the same pathology is beneficial in this population. A switch on atypical antipsychotics without anticholinergic properties for residual symptoms may also be helpful.