8/14/2023 0 Comments Pica symptomsTherefore, in AD patients having an oral tendency, effective treatments reported for pica in FTD, such as antidepressants ( 9, 10), could also be effective for their pica. The oral tendency is assumed to be the common pathological feature of pica in FTD and AD. Since pica itself can be a risk factor for asphyxia and aspiration, effective treatments that do not cause sedation and extrapyramidal symptoms need to be explored for pica in patients with AD. However, antipsychotics are associated with an increased risk of extrapyramidal symptoms and sedation. In AD, antipsychotic drugs such as haloperidol were reported to be effective against pica ( 11). In FTD, the effectiveness of some antidepressants such as trazodone ( 9) and fluvoxamine ( 10) has been demonstrated. Since the cause of pica in degenerative dementia has not been elucidated, there are only a few known effective drug therapies for this condition. In AD, it has been surmised that cognitive impairment, agnosia, and changes in taste and smell ( 8) are related to this condition. In FTD, binge eating and altered food preferences are also thought to be involved ( 7). The symptoms other than oral tendency that are involved in pica vary depending on the type of dementia. It has been reported in the literature that pica in degenerative dementia appears in association with an oral tendency, a symptomatology of “putting the object into the mouth, biting gently, chewing, licking, touching with the lips” ( 6). Therefore, effective treatments for this condition in degenerative dementia are greatly needed.Īlthough the etiology of pica in degenerative dementia remains unclear, multiple factors are thought to be involved ( 5). Pica can sometimes cause life-threatening events, such as asphyxia and aspiration ( 4). In FTD, pica can appear from the early stage, whereas in AD, it generally emerges in the late stage ( 3). Among degenerative dementias, frontotemporal dementia (FTD) is the most likely to have pica, but pica is also seen in 10% of patients with AD ( 2), making it difficult for caregivers to provide care. It is well-known that iron deficiency anemia can cause pica, but pica is also found in psychiatric conditions such as dementia, intellectual disability, autism, and schizophrenia ( 1). Pica is defined as the persistent eating of non-nutritive, non-food substances. Our case together with previous reports showing that trazodone and fluvoxamine were effective for pica in FTD suggest that the same common drug therapy may be successful in pica with oral tendency, regardless of the subtype of dementia. KBS is often seen in FTD, but also occurs in late-stage AD. In this case, pica with oral tendency, which was accompanied by prosopagnosia and placidity, may be interpreted as a partial symptom of Klüver–Bucy syndrome (KBS). Her pica behaviors then disappeared without daytime sleepiness. We then administered trazodone and fluvoxamine, both of which have demonstrated effectiveness for pica in frontotemporal dementia (FTD). She was given olanzapine and perospirone, but both were discontinued due to over-sedation and severe extrapyramidal symptoms, respectively. She took rivastigmine and memantine, but these were ineffective for her pica. Her pica was accompanied by oral tendency, prosopagnosia, and placidity. An 80-year-old woman with AD was admitted to our hospital due to aggravated pica, including eating weeds in the facility's garden and eating a dishwashing sponge. We report a case of AD with pica that was successfully improved by trazodone and fluvoxamine. However, few effective medications have been reported for pica in AD. Pica in Alzheimer's disease (AD) makes it difficult for caregivers to provide care. 2Medical Department, Kunpukai Yamada Hospital, Tokyo, Japan.
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