Behavioral and Psychological Signs and Symptoms of Dementia: A Consensus Statement on Current Knowledge and Implications for Research and Treatment

Abstract

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...

Validity and Reliability of the European Portuguese Version of Neuropsychiatric Inventory in an Institutionalized Sample

“…However, behavioral and psychological symptoms were excluded from the main international classifications and diagnostic criteria, playing a secondary role within the diagnosis of dementia. Later, in 1996, those non-cognitive manifestations of dementia were defined by the International Psychogeriatric Association as “signs and symptoms of disturbed perception, thought, content, mood, or behavior that frequently occur in patients with dementia.” [3, 4] and a large number of population-based studies confirmed the presence of this heterogeneous group of symptoms and behaviors.…”

Managing Resident-to-Resident Elder Mistreatment in Nursing Homes: The SEARCH Approach

“…There is also a small body of literature on the mistreatment of elderly residents by staff of nursing homes (Cohen, Halevy-Levin, Gagin, Priltuzky, & Friedman, 2010; Payne & Cikovic, 1994; Pillemer & Moore, 1989), and on aggressive behaviors experienced by family members and paid caregivers at the hands of older people with dementia (Finkel, Costa de Silva, Cohen, Miller, & Sartorius, 1997; Lachs et al, 2012). …”

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

“…This is important as caregiver burden is strongly linked to use of health, social and medical services by both the person with dementia and their caregiver. [65][66][67][68] Given the absence of impact on behavioural and psychological symptoms, it is unclear why caregivers from the TAU group reported having a significant worsening of burden in comparison with those in receipt of the intervention. The increase may have been due to worsening burden because of BPSD, differential physical burden between the two groups (there was a slightly higher number of physical conditions in the TAU group at baseline) or unhappiness among carers about not being randomised to the intervention.…”

“…This is surprising given that > 80% of people with dementia will experience BPSD at some point during the course of their illness. 65 BPSD have long been commonly associated with reduction in the quality of life for the person as well as their carers; 66 increase of caregiver stress, 67 higher costs of care; 68 and premature moves to long-term care facilities. 69 Although there is some evidence supporting the treatment of BPSD with antipsychotic drugs, there have been increasing concerns over the safety of these drugs for people with dementia.…”