Behavioral and Psychological Symptoms of Dementia: How Long Does Every Behavior Last, and Are Particular Behaviors Associated With PRN Antipsychotic Agent Use? (original) (raw)
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Assessment and management of behavioral and psychological symptoms of dementia
BMJ (Clinical research ed.), 2015
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 approache...
Behavioural and Psychological Problems in Dementia
Acta Scientific Medical Sciences, 2020
Behavioural disturbances in the form of agitation and aggression occur frequently in persons with dementia. Mean prevalence of behavioural disturbances in dementia is reported to be as high as 46.2%. Various psychological and behavioural symptoms reported in dementia apart from agitation and aggression include apathy, delusions, hallucinations, irritability, eating disturbances and sleep disorders. Other symptoms seen include hyperactivity, affective symptoms including depression and anxiety. The neurobiological changes seen in dementia include decrease in cholinergic and serotonergic activity, alterations in the noradrenergic systems; decrease in the norepinephrine level and an increase in the level of its major metabolite 3-methoxy-4-hydroxyphcnylglycol. Tools used for assessing include the behavioral pathology in Alzheimer's disease rating scale (BFHAVE-AD), the Cohen-Mansfield Agitation Inventory (CMAI), the neuropsychiatric inventory (NPI) and the behavioral rating scale for dementia (BRSD). A variety of treatments are available to alleviate the behavioural symptoms. Antipsychotics have been found to be the treatment of choice for behavioural disturbances. Treatment of depression in dementia comprises pharmacotherapy and nonpharmacological strategies, such as psychological interventions to enhance quality of life. Psychological intervention begins with the development of a daily routine and the organization of activities which the patient enjoys. A detailed treatment regime is discussed in the article below.
Behavioral and Psychologic Symptoms in Different Types of Dementia
Journal of the Formosan Medical Association, 2006
Background/Purpose: Behavioral and psychologic symptoms of dementia (BPSD) are major sources of a caregiver's burden and also the most important factor when considering the need for institutionalization of dementia patients. BPSD occur in about 90% of patients with dementia. Studies comparing the BPSD in the major types of dementia using unitary behavioral rating scales are limited. We studied BPSD in patients with four major types of dementias from a memory clinic. Methods: We recruited patients with dementia from our memory clinic from January 2003 to February 2004. The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) was used to measure BPSD severity. Clinical Dementia Rating and Mini Mental State Examination were used to determine dementia severity. Results: A total of 137 patients with four major types of dementia were recruited from 155 patients with dementia who attended the clinic during the study period. The main dementia types identified were Alzheimer's dementia (AD) in 54.8%, vascular dementia (VaD) in 20.6%, frontotemporal dementia (FTD) in 8.4%, dementia with Lewy bodies (DLB) in 4.5%, and other dementias in 11.6%. BPSD were found in 92.0% of the patients but only 43.1% received psychotropic treatment. The relative risk of receiving psychotropic treatment for BPSD subscales paralleled the extent of caregivers' burden as assessed by the BEHAVE-AD global rating. Type-specific BPSD, e.g. hallucination was identified for DLB, activity disturbances for FTD, anxiety and phobias for AD and affective disturbance for VaD. Conclusion: A strategy of targeting type-specific BPSD may be beneficial, such as environmental stimulus control for DLB patients who are prone to have hallucinations, design of a pacing path for patients with FTD who need support for symptoms of wandering and emotional support for patients with VaD who are susceptible to depression. [
International Journal of Geriatric Psychiatry, 1997
Background/Objective: There were few studies identifying the natural unfolding of behavioural and psychological symptoms of dementia (BPSD) in the course of Alzheimer's disease (AD) progression in antipsychotic-naïve AD patients. This study aims to examine the specific nature of the association between BPSD in AD and the global severity of illness measured by Global Deterioration Scale(GDS) in antipsychotic-naïve AD patients in Korea. Methods: A total of 562 antipsychotics-naïve AD patients were recruited from four different groups [a geriatric mental hospital (n = 145), a semi-hospitalized dementia institution (n = 120), a dementia clinic (n = 114) and communitydwelling dementia patients (n = 183)]. BPSD exhibited by AD patients were measured using the 25-item Korean version of the BEHAVE-AD. Results: Ninety-two percent (n = 517) of AD patients had at least one BPSD, while 56% (n = 315) had 4 or more BPSD. Specific kinds of behavioral disturbance peak at the stages of moderate AD (GDS stage 5) or moderately severe AD (GDS stage 6). AD patients left at home without any treatment had higher frequency of BPSD than did other groups seeking treatment, although all of them were antipsychotic-naïve. Conclusion: BPSD potentially remediable to treatment were highly frequent in Korean AD patients. Health policies to meet the unmet needs of elderly Koreans are urgently needed, especially for AD patients at home without treatment.
Nonpharmacologic Management of Behavioral Symptoms in Dementia
JAMA, 2012
Behavioral symptoms such as repetitive statements and questions, wandering, and sleep disturbances are a core clinical feature of Alzheimer disease and related dementias, affecting patients and their families. These behaviors have devastating effects. If untreated, they can contribute to more rapid disease progression, earlier nursing home placement, worse quality of life, accelerated functional decline, greater caregiver distress, and higher health care utilization and costs. Patients with dementia are typically not screened for behavioral symptoms in primary care and even when clinically reported, tend to receive ineffective, inappropriate, and fragmented care. Yet, clinicians are often called upon to address behaviors that place the patient or others at risk or which families encounter as problematic. It is important to include ongoing systematic screening for behavioral symptoms to facilitate prevention and early treatment as part of standard comprehensive dementia care. When identified, behaviors should be characterized and underlying causes sought in order to derive a treatment plan. Because available pharmacologic treatments used to treat behaviors have modest efficacy at best, are associated with notable risks, and do not address behaviors most distressing for families, nonpharmacologic options are recommended as first-line treatments or if necessary, in parallel with pharmacologic or other treatment options. Nonpharmacologic treatments may include a general approach (caregiver education and training in problem solving, communication and task simplification skills, patient exercise, and/or activity programs), or a targeted approach in which precipitating conditions of a specific behavior are identified and modified (eg, implementing nighttime routines to address sleep disturbances). Using the case of Mr A, we characterize common behavioral symptoms of dementia and describe an assessment strategy for selecting evidence-based nonpharmacologic treatments. We highlight the clinician's important role in facilitating collaboration with specialists and other health care professionals to implement nonpharmacological treatment plans. Substantial evidence shows that nonpharmacologic approaches can yield high levels of patient and caregiver satisfaction, quality of life improvements, and reductions in behavioral symptoms. Although access to nonpharmacologic approaches is currently limited, they should be part of standard dementia care.
The Biological Basis of Behavioral Symptoms in Dementia
Issues in Mental Health Nursing, 2000
This article describes the pathophysiology of dementia and differentiates between cognitive and noncognitive symptoms that characterize this devastating illness. Relationships between brain anatomic and neurochemical systems and behavioral symptoms of dementia are discussed. An overview of the etiologies and neuropathologiesof dementia are presented as they relate to impairments in memory and intellectual abilities, personality changes, and behavioral symptoms. Recent genetic and molecular discoveries that have advanced our understanding of this complex spectrum of disorders and their treatment(s) are also highlighted. More than 70 diseases/disorders are associated with the progressive loss of memory and intellectual function known as dementia, although Alzheimer's disease (AD) is by far the most common cause. Current estimates suggest that more than four million Americans suffer from AD (Advisory Panel on Alzheimer's Disease, 1995). Although the diagnosis of dementia focuses on the clinical presentation of cognitive deficits, complex disturbances of behavior and emotion have been recognized as part of the disorder since Alois Alzheimer's original case report in 1907 describing the cerebral cortex and abnormal behaviors of a 55-yearold woman (Alzheimer, 1987). In contrast to the cognitive symptoms, which usually follow a welldescribed course of progressive decline, the occurrence and course of the noncognitive symptoms in dementia are less predictable (Tariot, 1994), developing at any stage during the disease process (Eisdorfer et al., 1992). There is a discrepancy between the labeling of symptoms by health care professionals and complaints by family members about their loved one's behavior. For example, dementia is generally defined by clinicians as progressive deterioration of cognitive abilities, however families of dementia patients often define the stages of illness with behavioral (noncognitive) markers. In fact, behavioral complications are a leading cause of institutionalization in persons with dementia (Knopman, Kitto, Deinard, & Heiring, 1988; Steele, Rovner, Chase, & Folstein, 1990). Disease progression is not measured simply by declining scores on the Mini-Mental State Exam or other clinical rating scales, but rather includes such symptoms as the amount of sleeplessness at night, the person's degree of agitation or psychosis, and the level of depressed mood. A key unanswered scientific question is how central these noncognitive behavioral symptoms are to
Merrill 2011 Principles Practice Geripsych Chapter 53 AD Beh Sympt Psychopharm
In this chapter, descriptions of the most common behavioural disturbances observed in AD and other dementias are provided, followed by examples of common measurement tools used in research to study these symptoms. The currently available pharmacological options for treating the behavioural symptoms of dementia are then reviewed, highlighting areas in which data can help guide targeted treatment of specific symptoms. This chapter concludes with a discussion of general treatment principles, intended to aid clinicians in an era when there are not clearly benign and beneficial treatment options available to address the ongoing severe and complex behavioural symptoms of dementia.