Behavioral and psychotic symptoms of dementia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: BPSD

Overriew

BPSD is defined as "symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia".

Pathophysiology

The cause of BPSD is not clear. It has been hypothesized to be due to abnormalities in the way information is processed, integrated, and retrieved.

Causes

• Alzheimer's disease
• Multi-infarct dementia
• Lewy body dementia

Natural History, Complications and Prognosis

Natural History

The symptoms may progress or certain symptoms occur during certain phases of the illness.

Complications

• Premature institutionalization
• Increased cost
• Reduced quality of life for both caregiver and patient
• Caregive stress
• Nursing staff stress

Diagnosis

Symptoms

In the original description of Alzheimer's disease by Alois Alzheimer in 1906, the following symptos figured prominently:

• Aggression and hostility in 20% of patients
• Agitation
• Cursing
• Delusions of sexual abuse in 20%-73% of patients
• Depressive mood
• Hallucinations in 15% to 49% of patients
• Hoarding
• Misidentifications in 23% to 50% of patients
• Paranoia
• Screaming
• Sexual disinhibition
• Shadowing
• Wandering

Guidelines

The Alzheimer's Association recommends training and education for both professional and family caregivers on psychosocial interventions that might include :

“

Routine activity. Separate the person from what seems to be upsetting him or her. Assess for the presence of pain, constipation or other physical problem. Review medications, especially new medications Travel with them to where they are in time. Don’t disagree; respect the person’s thoughts even if incorrect. Physical interaction: Maintain eye contact, get to their height level, and allow space. Speak slowly and calmly in a normal tone of voice. The person may not understand the words spoken, but he or she may pick up the tone of the voice behind the words and respond to that. Avoid point finger-pointing, scolding or threatening. Redirect the person to participate in an enjoyable activity or offer comfort food he or she may recognize and like. If you appear to be the cause of the problem, leave the room for a while. Validate that the person seems to be upset over something. Reassure the person that you want to help and that you love him or her. Avoid asking the person to do what appears to trigger an agitated or aggressive response. In making the decision to utilize antipsychotic therapy the following should be considered: Identify and remove triggers for BPSD: pain, under/over stimulation, disruption of routine, infection, change in caregiver, etc. Initiate non-pharmacologic alternatives as first-line therapy for control of behaviors Assess severity and consequences of BPSD. Less-severe behaviors with limited consequences of harm to individual or caregiver are appropriate for non-pharmacologic therapy, not antipsychotic therapy. However, more severe or “high risk” behaviors such as frightening hallucinations, delusions or hitting may require addition of antipsychotic trial. Determine overall risk to self or others of BPSD, and discuss with doctor the risks and benefits with and without antipsychotics. Some behaviors may be so frequent and escalating that they result in harm to the person with dementia and caregiver that will in essence limit the life-expectancy and or quality of life of the person with Alzheimer’s disease. Accept that this is a short-term intervention that must be re-evaluated with your health care professional for appropriate time of cessation.

”