A Narrative Review of the Management of Behavioral and Psychological Symptoms of Dementia

Abstract

Dementia is a chronic or progressive neurodegenerative condition which is organic in origin. There will be impairment of thinking, memory orientation, comprehension, language, calculation, and judgement. Alzheimer's disease facts and gures in 2021 according to Alzheimer's association shows Alzheimer's disease accounts for 60% to 80% of the total cases. Behavioural and psychological symptoms of dementia also known as neuropsychiatric symptoms are a group of symptoms with behavioural and psychological manifestations. Disturbances include behavioural symptoms like wandering, hoarding, physical aggression, sexually disinhibition, culturally inappropriate behaviour, agitation and psychological symptoms like apathy, depression, anxiety, delusions, and hallucinations, sundowning, elation. Scales like the Neuropsychiatric Inventory, the Behavioural Pathology in Alzheimer Disease rating scale, the Consortium to Establish a Registry for Alzheimer Disease Behaviour Rating Scale for Dementia, Dementia Behaviour Disturbance scale, and the Neurobehavioral Rating Scale can be utilized to recognise BPSD.Neuropsychological assessment also have an important role. Non-pharmacological methodologies contain different sorts of treatment: tactile stimulation, pressure point massage, fragrant healing, light treatment, garden exercises, music therapy, dance therapy, and Snoezelen multisensory therapy, psychological strategies of multicomponent treatment strategies. Broadly focussing on sensory stimulation, social activities, structural activities, behavioural activities, environmental activities, and training programmes. Pharmacological treatment includes antipsychotics, mood stabilizers and antidepressants in treating BPSD, and cholinesterase inhibitors and memantine for the situation of Alzheimer's dementia sedative/hypnotics for sleep issues. Treatment can be further categorized based on individual NPS like agitation, psychosis, apathy, depression, sleep problems and other symptoms. Future treatment which has less evidence as of now includes rTMS, TDCS and Photo biomodulation therapy