Assessment and management of behavioral and psychological symptoms of dementia

Abstract

Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

“…Behavioural charts were completed with several patients; however, these became a replication of the nursing notes and did not appear to change the care plan. This concurs with community studies which have found that clinicians feel that they do not have the resources, time, or knowledge required to implement non‐pharmacological intervention (Ballard et al ., 2009; Kales et al ., 2015; Bishara et al ., 2009). Recent reports such as ‘Meeting needs and reducing distress’(2014) and a randomised controlled trial looking at the effectiveness of specialist units (Goldberg et al ., 2013) are beginning to detail practical guidance on managing challenging behaviours within the acute setting; however, more evidence‐based research is needed.…”

Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations

“…446 Although neuropsychiatric symptoms are almost universal if individuals are considered throughout the course of the disease, individuals with mild to moderate dementia occasionally have no neuropsychiatric symptoms and frequently have no clinically significant symptoms. For example, 94% of participants with dementia in a study designed to be representative of people with AD had one or more neuropsychiatric symptoms, but only 74% had clinically significant symptoms.…”

Medications used in dementia: a review of evidence

“…Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors (41). As dementia progresses treatment of behavioural and psychological symptoms become more difficult.…”