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The Role of Norepinephrine in the Behavioral and Psychological Symptoms of Dementia

Received August 1, 2002; revised October 29, 2002; accepted November 18, 2002. From the Division of Geriatric Psychiatry, Sunnybrook and Women's College Health Sciences Centre, Geriatric Psychiatry, Department of Psychiatry, University of Toronto; HOPE Research Centre, Sunnybrook and Women's College Health Sciences Centre, Departments of Psychiatry and Pharmacology, University of Toronto. Address correspondence to Dr. Herrmann, Division of Geriatric Psychiatry, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Room FG05, Toronto, ON M4N 3M5, Canada; Nathan.Herrmann{at}sw.ca (E-mail).

The behavioral and psychological symptoms of dementia (BPSD) are common serious problems that are a major contributor to caregiver burden. Despite their significance, the underlying neurobiology of these disturbances is still unclear. This review examines the role of norepinephrine (NE) on BPSD, including depression, aggression, agitation and psychosis. A number of lines of evidence suggest that NE dysfunction leading to BPSD may result from increased NE activity and/or hypersensitive adrenoreceptors compensating for loss of NE neurons with progression of Alzheimer’s disease (AD). With greater appreciation of the underlying neurobiology of behavioral and psychological symptoms of dementia (BPSD) more effective, rational, targeted pharmacotherapy will hopefully emerge.

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