Behavioral and psychotic symptoms of dementia: Difference between revisions
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__NOTOC__ | |||
{{Alzheimer's disease}} | |||
{{CMG}} | |||
{{SK}} BPSD | |||
==Overriew== | |||
BPSD is defined as "symptoms of disturbed perception, thought content, mood or behavior that frequently occur in | |||
patients with dementia".<ref>Finkel & Burns, 1999</ref> | |||
==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.<ref>http://www.alz.org/national/documents/statements_antipsychotics.pdf</ref> | |||
==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]] | |||
==Treatment== | |||
==Guidelines== | ==Guidelines== | ||
The Association recommends training and education for both professional and family caregivers | The Alzheimer's Association recommends training and education for both professional and family caregivers on psychosocial interventions that might include <ref>http://www.alz.org/national/documents/statements_antipsychotics.pdf</ref>: | ||
on psychosocial interventions that might include: | {{cquote| | ||
*Routine activity. | *Routine activity. | ||
*Separate the person from what seems to be upsetting him or her. | *Separate the person from what seems to be upsetting him or her. | ||
| Line 9: | Line 56: | ||
*Don’t disagree; respect the person’s thoughts even if incorrect. | *Don’t disagree; respect the person’s thoughts even if incorrect. | ||
*Physical interaction: Maintain eye contact, get to their height level, and allow space. | *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 | *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. | ||
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. | *Avoid point finger-pointing, scolding or threatening. | ||
*Redirect the person to participate in an enjoyable activity or offer comfort food he or she | *Redirect the person to participate in an enjoyable activity or offer comfort food he or she may recognize and like. | ||
may recognize and like. | |||
*If you appear to be the cause of the problem, leave the room for a while. | *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 | *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. | ||
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. | *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: | *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 | :*Identify and remove triggers for BPSD: pain, under/over stimulation, disruption of routine, infection, change in caregiver, etc. | ||
routine, infection, change in caregiver, etc. | |||
:*Initiate non-pharmacologic alternatives as first-line therapy for control of behaviors | :*Initiate non-pharmacologic alternatives as first-line therapy for control of behaviors | ||
:*Assess severity and consequences of BPSD. Less-severe behaviors with limited | :*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. | ||
consequences of harm to individual or caregiver are appropriate for non-pharmacologic | :*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. | ||
therapy, not antipsychotic therapy. However, more severe or “high risk” behaviors such as | :* Accept that this is a short-term intervention that must be re-evaluated with your health care professional for appropriate time of cessation.}} | ||
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 | ==References== | ||
benefits with and without antipsychotics. Some behaviors may be so frequent and | {{Reflist|2}} | ||
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. | |||
Latest revision as of 23:24, 15 September 2012
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Behavioral and psychotic symptoms of dementia On the Web |
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American Roentgen Ray Society Images of Behavioral and psychotic symptoms of dementia |
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Risk calculators and risk factors for Behavioral and psychotic symptoms of dementia |
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".[1]
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.[2]
Causes
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
Treatment
Guidelines
The Alzheimer's Association recommends training and education for both professional and family caregivers on psychosocial interventions that might include [3]:
| “ |
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” |