title: Difficult behaviors in long-term care patients with dementia.
abstract: Difficult behaviors are relatively common challenges that can occur throughout the natural progression of dementia, but are particularly common in the mid to late stages of disease. These behaviors can be challenging to manage in nursing and assisted care facilities, and can cause distress to the caregivers and to the patients themselves. Our ability to manage these symptoms can have a profound effect on the patient's quality of life. This article reviews the appropriate assessment of behavioral and psychological symptoms of dementia (BPSD) and the literature supporting various nonpharmacologic and pharmacologic treatments. Nonpharmacologic approaches should be the initial focus for treatment of most BPSD, but should these prove inadequate, a variety of medications are available with varying degrees of clinical research to support their use in ameliorating BPSD.
authors.affiliation: Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA. buhr0001@mc.duke.edu
authors.forename: Gwendolen T
authors.initials: GT
authors.lastname: Buhr
authors.forename: Heidi K
authors.initials: HK
authors.lastname: White
mesh_terms: D000368:Aged; D000786:Anger; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003704:Dementia / Q000150:complications*; D003863:Depression / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005851:Geriatric Nursing / Q000379:methods; D005853:Geriatrics / Q000379:methods; D006801:Humans; D007508:Irritable Mood; D008134:Long-Term Care / Q000379:methods*; D008487:Medical History Taking; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D018579:Patient Selection; D010808:Physical Examination; D011788:Quality of Life; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D016194:Receptors, N-Methyl-D-Aspartate; D017367:Selective Serotonin Reuptake Inhibitors