This study evaluated outcomes of an inpatient program designed to reduce severe agitated behavior in geriatric patients with dementia who could not be successfully treated on an outpatient basis. An individualized treatment plan was created for each patient (N = 250) that involved pharmacological and nonpharmacological interventions with behavioral, environmental, and psychological components. Assessment of behavioral, cognitive, and functional status was conducted for each patient on admission to the program and at discharge. Significant improvements on these assessments were observed. We conclude that the longitudinal, multidisciplinary approach used in this study was effective in significantly reducing intrusive and dangerous behaviors while preserving or enhancing patients' cognitive and functional abilities.

The behavioral variant of frontotemporal dementia (FTD) begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders, like schizophrenia, can be challenging. This paper presents a case of traumatic brain injury with subsequent depression and catatonia. Initial response to electroconvulsive therapy and lorazepam suggested primarily psychiatric pathology. Subsequent symptom progression, reduced treatment response, and detailed family history evaluation led to the diagnosis of familial FTD with C9ORF72 mutation. This case highlights that familial FTD can present with depression with suicidal tendencies and catatonia, and that the responsiveness of these behavioral manifestations to standard therapies can change over time.

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Two patients diagnosed with dementia with Lewy bodies (DLB) presented with prominent behavioral disturbances. The first patient experienced well-formed visual hallucinations, movement disorders, and cognitive decline and was increasingly resistant to care. He was treated with galantamine 4 mg bid, which was increased to 8 mg bid after four weeks. Improvements in behavior, attention, and cognition made it possible for this patient to be transferred back to long-term care after 32 days. The second patient had increasing confusion, fluctuating cognition, agitation, and psychosis. He was given donepezil initially, then switched to galantamine 4 mg bid. He was assessed as stable for discharge with improved behavior control after three weeks. Both patients also were receiving an atypical antipsychotic (quetiapine) and an antidepressant (venlafaxine and sertraline, respectively).