The behavioral (eg repetitive questioning, hitting) and psychological (eg delusions, anxieties) signs and symptoms of dementia can result in suering, premature institutionalization, increased costs of care and signi®cant loss in the quality of life for the patient and his or her family and caregivers.In the past, these symptoms received less attention than the cognitive symptoms of dementia. They were not always seen as symptoms of a brain disease requiring treatment, nor was there sucient awareness of treatment opportunities. Changes in social structure (eg the diminution of households) and the growing numbers of elderly people suering from dementia worldwide now make it imperative to ®nd ways of dealing with these symptoms in a humane and eective way.A major reason for holding a conference on the behavioral and psychological signs and symptoms of dementia and for preparing this consensus statement is that many of these signs and symptoms are still not generally considered to be amenable to intervention and treatment by the healthcare profession. In fact, they are among the core symptoms of dementia, and it is as essential to study and treat them as it is to study and treat any other aspects of dementing disorders.
DEFINITIONThe chief characteristics of dementia include multiple cognitive de®cits and a deteriorating course. In addition to the cognitive symptoms, people with dementia have other symptoms that have been largely neglected until recently. These other symptoms have commonly been called behavioral disturbances of dementia. The participants of the Conference thought that the term`disturbances' is too general, has many meanings and is dicult to de®ne. They recommended that the term`behavioral disturbances' be replaced by the term`behavioral and psychological signs and symptoms', de®ned as follows:Signs and symptoms of disturbed perception, thought content, mood, or behavior that frequently occur in patients with dementia
SIGNS AND SYMPTOMSThere are many ways in which behavioral and psychological signs and symptoms can be grouped. The participants recognized that for certain purposes it might be useful to group them into psychopathologically recognized symptom clusters (eg depressive syndrome, psychotic syndrome); for other purposes they might be organized by function (eg disorders of sleep) or by altered behavior (eg hitting, wandering). A simple method of grouping could be:. Symptoms usually and mainly assessed on the basis of interviews with patients and relatives; these symptoms include anxiety, depressive mood, hallucinations and delusions; and . Symptoms usually identi®ed on the basis of observation of patient behavior, including aggression, screaming, restlessness, agitation, wandering, culturally inappropriate behaviors, sexual disinhibition, hoarding, cursing and shadowing.Although numerous techniques are available to assess these symptoms in a reliable manner, most of these have not been tested in more than one cultural setting. A major research task ahead will be studies leading to cross-cultur...
