Managing challenging behaviours in dementia

Abstract

Dementia is a condition marked by the progressive and irreversible clinical syndrome of cognitive decline, which is eventually severe enough to interfere with daily living. Management of dementia is often complex and requires a multidisciplinary approach. This is the last article in our dementia series, after our previous two articles, 'Approach to the forgetful patient' (1) and 'Dementia management: a brief overview for primary care clinicians' (2) that discussed making the diagnosis and management of dementia. In this article, we discussed the behavioural and psychological symptoms of dementia (BPSD), such as agitation, insomnia, restlessness, hallucinations, anxiety and depressed mood. These can cause significant distress to families and caregivers, and may even lead to premature institutionalisation of the patient. Management consists of assessment of BPSD and supporting the needs of the family or caregiver.

Nurses' support needs in providing high‐quality palliative care to persons with dementia in the hospital setting: A cross‐sectional survey study

“…Additional training in communication with families about end-of-life care is needed to improve the quality of life for persons with dementia (Ooi et al, 2018).…”

Physical exercise as a non-pharmacological strategy for reducing behavioral and psychological symptoms in elderly with mild cognitive impairment and dementia: a systematic review of randomized clinical trials

“…The majority of the studies were conducted in longterm facilities. These facilities tend to house a large proportion of the elderly population with dementia, as this is one of the main causes of institutionalization of the elderly 27 . The included studies analyzed different stages of dementia (MCI and advanced dementia).…”

Behavioural and Psychological Symptoms of Dementia – Assessment and Management

“…• Cognitive enhancers such as acetylcholinesterase inhibitors and NMDA receptor antagonist have conflicting evidence to support their use in the management of BPSD, but they do benefit cognition. 45 When using drugs in elderly patients with dementia, due consideration must be given to the age and disease-related changes in the pharmacokinetic and pharmacodynamic properties of the prescribed drug. Prescribing must be informed and judicious, starting at low doses, with slow and cautious titration, whilst carefully monitoring for emergence of side effects.…”