Behavioral and Psychological Symptoms of Dementia as a Means of Communication: Considerations for Reducing Stigma and Promoting Person-Centered Care

Abstract

Dementia has rapidly become a major global health crisis. As the aging population continues to increase, the burden increases commensurately on both individual and societal levels. The behavioral and psychological symptoms of dementia (BPSD) are a prominent clinical feature of Alzheimer’s disease and related dementias (ADRD). BPSD represent a myriad of manifestations that can create significant challenges for persons living with dementia and their care providers. As such, BPSD can result in detriments to social interaction with others, resulting in harm to the psychosocial health of the person with dementia. While brain deterioration can contribute to BPSD as the disease progresses, it may be confounded by language and communication difficulties associated with ADRD. Indeed, when a person with dementia cannot effectively communicate their needs, including basic needs such as hunger or toileting, nor symptoms of pain or discomfort, it may manifest as BPSD. In this way, a person with dementia may be attempting to communicate with what little resources are available to them in the form of emotional expression. Failing to recognize unmet needs compromises care and can reduce quality of life. Moreover, failing to fulfill said needs can also deteriorate communication and social bonds with loved ones and caregivers. The aim of this review is to bring the differential of unmet needs to the forefront of BPSD interpretation for both formal and informal caregivers. The overarching goal is to provide evidence to reframe the approach with which caregivers view the manifestations of BPSD to ensure quality of care for persons with dementia. Understanding that BPSD may, in fact, be attempts to communicate unmet needs in persons with dementia may facilitate clinical care decisions, promote quality of life, reduce stigma, and foster positive communications.

Studies on the mechanism of Toxoplasma gondii Chinese 1 genotype Wh6 strain causing mice abnormal cognitive behavior

“…Furthermore, the OFT showed that the infected mice had an obvious corner preference, which is related to increased anxiety. It has been reported that anxiety-like behavior is also common in AD patients [ 39 , 40 ]; meanwhile, the data from the MWMT revealed that TgCtwh6 infection damaged the mouse spatial memory retention and spatial learning. However, the infected mice had normal mobility, suggesting that T. gondii infection hardly affects motor function in mice [ 41 , 42 ].…”

Exploring why “memory loss” is a misleading descriptor of people living with dementia and can lead to dysfunctional care

“…Persons with dementia maintain gaze with their partners, retain emotional traces of film clips, and can have accentuated responses to social contagion (Fredericks et al, 2018). Additionally, though some brain networks deteriorate, those that become heightened can at times account for psychosocial changes (Cope et al, 2022; Warren, 2022). These networks correspond to heightened emotions and implicit memory and, when negative, are often mistaken for the behavioral and psychological symptoms of dementia, rather than meaningful attempts to communicate unmet needs (Warren, 2022).…”

Association between grip strength and cognitive impairment in older American adults

“…Increases are expected globally as a result of population growth and aging, and cognitive decline warrants urgent attention from policymakers and governments (Carroll, 2019 ). Reportedly, 6.2 million Americans aged ≥65 years are diagnosed with Alzheimer's disease (AD), and 13.8 million Americans are expected to have AD by 2060 (Warren, 2022 ). Therefore, AD and cognitive decline are associated with a high socioeconomic burden in the United States (US), and the burden is expected to increase 2-fold to 3.3% of the population by 2060 (Matthews et al, 2019 ).…”