Pharmacological management of behavioural and psychological symptoms of dementia

Abstract

Behavioural and psychological symptoms of dementia (BPSD) are a heterogenous cluster of symptoms associated with dementia. They place a significant burden on patients, carers and the health system. BPSD commonly present as apathy and depression, and in more severe cases agitation, aggression and psychosis. Approaches to BPSD management include non-pharmacological and pharmacological treatments. Several classes of medication, including antipsychotic agents, antidepressants, acetylcholinesterase inhibitors and analgesics, may have small but significant effects on BPSD in some patients. However, the side effect profiles of these medications commonly limit their use, and an understanding of their potential for adverse effects coupled with careful ongoing observation is crucial. This review focuses on the pharmacological treatment of BPSD and selection of treatments based on patients' presenting symptoms and expected adverse drug reactions.

Ward based management of behavioural and psychological symptoms of dementia

“…The NMDA antagonist (memantine) is useful to treat hallucinations, agitation, and aggression 1231. Use of personalised pain treatments can improve aggression, pacing, and restlessness 3132.…”

“…The NMDA antagonist (memantine) is useful to treat hallucinations, agitation, and aggression 1231. Use of personalised pain treatments can improve aggression, pacing, and restlessness 3132. Agitation, aggression, and psychosis can be treated with atypical anti-psychotics: among these risperidone, aripiprazole, and quetiapine show good efficacy and quick onset of action (within 1-2 weeks) 3233.…”

“…Agitation, aggression, and psychosis can be treated with atypical anti-psychotics: among these risperidone, aripiprazole, and quetiapine show good efficacy and quick onset of action (within 1-2 weeks) 3233. Typical antipsychotics such as haloperidol should be avoided in Lewy body dementia and Parkinson’s disease related dementia as they can markedly worsen parkinsonism, cause extra-pyramidal side effects, and substantially increase the risk of vascular disease 331. All antipsychotics should be reviewed after six weeks, as recommended by NICE guidelines 34…”

“…In severe depression, consider anxiety or agitation treatment such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors. Within SSRIs, citalopram and sertraline have the best evidence base 123132. Citalopram has efficacy comparable with risperidone in reducing agitation and is better tolerated, however it can impair cognition, has a slow onset of action (at least nine weeks), and can prolong the QT interval 3132…”

“…Within SSRIs, citalopram and sertraline have the best evidence base 123132. Citalopram has efficacy comparable with risperidone in reducing agitation and is better tolerated, however it can impair cognition, has a slow onset of action (at least nine weeks), and can prolong the QT interval 3132…”