Behavioral and Psychological Symptoms of Dementia - Abstract
More than 50% of people with dementia experience behavioral and psychological symptoms of dementia (BPSD). The development of BPSD is associated with a more rapid rate of cognitive decline, greater impairment in activities of daily living, and diminished quality of life. The most prevalent BPSD are apathy, depression, irritability, agitation and anxiety, The first step to better understand the psychiatric manifestations of dementia is to appropriately recognize and describe types of behavioral and psychological symptoms of dementia.
The delusions are typically less complex and organized. Visual hallucinations are particularly common in subjects with dementia with Lewy bodies. Wandering is a frequent behavioral disorder in demented patients. The basis of wandering is multifactorial; biomedical, psychosocial and person-environment factors must be considered. Aggressiveness or aberrant motor behavior has been more frequently reported in men with dementia. Appetite changes are particularly frequent in frontotemporal dementia.
BPSD may respond to those environmental and psychosocial interventions, however, drug therapy is often required for more severe presentations. There are multiple classes of drugs used for BPSD, including antipsychotics, anticonvulsants, antidepressants, anxiolytics, cholinesterase inhibitors and NMDA modulators. It was concluded that there were small but statistically significant benefits using aripiprazole, olanzapine, and risperidone in the treatment of BPSD. The guideline is to minimize antipsychotic use in older people with dementia, to initiate antipsychotics only in patients with severe distress, and to limit the dose and treatment duration.